States Tackle the Climbing Maternal Mortality Rate in the U.S.

March 18, 2020 | ASTHO Staff

There are two alarming health trends on the rise affecting women across the United States: maternal mortality, a death resulting from pregnancy or delivery complications, and severe maternal morbidity—characterized as short- or long-term mental and physical health consequences resulting from a woman’s pregnancy or delivery. The U.S. is the only developed country with an increasing rate of maternal mortality. Data from the CDC indicates that nearly 60 percent of maternal deaths in the U.S. are preventable and most occur within 42 days of the postpartum period.

Recent legislative approaches to reduce and prevent maternal mortality and morbidity include establishing maternal mortality review committees (MMRCs) or expanding the scope of MMRCs to include maternal morbidity. ASTHO expects states to adopt additional laws to expand the type of information available for review by MMRCs, improve screening and treatment for postpartum depression and substance use, create maternal health advisory councils for interagency coordination and policy recommendations, and identify the causes of and reduce disparate rates of maternal mortality and morbidity among women of color. Below is an overview of legislative activity from the current session to address the high prevalence of maternal mortality and morbidity in the U.S. More information can also be found in ASTHO’s legislative prospectus on maternal mortality review.

Establishing and Conducting a Maternal Mortality and Morbidity Review

Maternal mortality review committees (MMRCs) are one of the best ways to gather information on why pregnancy-related deaths occur and how to prevent them. Studies show that MMRCs can reduce maternal mortality by 20-50 percent since they examine the underlying causes of maternal mortality, use data to identify gaps in care, and inform a focused approach to prevent deaths and reduce disparities. At least 40 states now have MMRCs, most of them established and administered by statute.

Minnesota is considering a bill to expand the maternal death studies conducted by the commissioner of health to include maternal morbidity. Maine proposed legislation that would amend the laws governing its Maternal, Fetal and Infant Mortality Review Panel to require the review of maternal deaths that occur within one year of giving birth, rather than 42 days.

An Oklahoma bill would require attending physicians to report the death of women in hospitals after delivery from any cause related to or aggravated by the pregnancy or its management to the Department of Health. In addition, if a woman dies within 42 days of the end of her pregnancy from any cause related to or aggravated by the pregnancy or its management, the person making the determination of death has to report the death to the Department of Health. In both scenarios, the bill requires the provision of a place on the death certificate where the medical examiner can indicate that the death was related to maternal mortality. The Department of Health is required to include data on maternal mortality on its website.

In Vermont, a proposed bill would allow the commissioner to include licensed clinical providers specializing in substance use disorder, experts in pharmaceutical management of mental health, and social workers in the state’s Maternal Mortality Review Panel for one-year terms. The bill would also allow the Department of Health to enter into reciprocal agreements with other states that have maternal mortality review panels. The state Senate is considering the bill after passing in the House.

A West Virginia bill would require the Fatality and Mortality Review Team to establish several advisory panels, including: an unintentional pharmaceutical drug overdose fatality review panel; a child fatality review panel; a domestic violence fatality review panel; and an infant and maternal mortality review panel. The bill passed both the state Senate and House, and the Senate is reconsidering the bill with house amendments.

Reducing Racial and Ethnic Health Disparities

According to data from the CDC’s Pregnancy Mortality Surveillance System, non-Hispanic black women are three times more likely to die from pregnancy-related complications compared to their white non-Hispanic counterparts. African-American women are more likely to die from pregnancy-related deaths, even after controlling for factors such as age, prenatal care, and income, according to recent studies. Several states have introduced bills that explicitly seek to reduce racial and ethnic disparities in maternal mortality rates.

Missouri is considering a bill that would expand the duties of the Pregnancy-Associated Mortality Review Board to include consideration of the role of race, ethnicity, language, poverty, literacy, and other social determinants of health when conducting reviews of maternal morbidity, mortality, and other clinically important metrics.

A Kentucky bill would mandate that the Department for Public Health establish a state child and Maternal Fatality Review Team (previously language made the establishment optional). In addition, the Department for Public Health would be required to track and publish data on maternal death and severe morbidity. Similarly, Georgia is considering a bill (HB 745) requiring the Department of Health to collect and track data on severe maternal morbidity and pregnancy related deaths, with a report then published every three years at least. Both states’ bills seek to address health equity and disparity concerns by requiring that the data collected be disaggregated and published by race and ethnicity. Georgia is also considering House Resolution 1248 to create the House Study Committee on Infant and Maternal Mortality Among African Americans. It would be responsible for studying the conditions, needs, issues, and problems that result in higher mortality rates for women of color and recommend any action or legislation deemed necessary to address disparate health outcomes.

In Massachusetts, the legislature proposed a bill to establish a special legislative commission to investigate and report on: evidence-based or best practices to reduce or eliminate racial disparities in maternal mortality or severe maternal morbidity; barriers to accessing prenatal and postpartum care; how that care is delivered; and the quality of that care; how historical and current structural, institutional, and individual forms of racism affect the incidence and prevalence of maternal mortality and severe maternal morbidity; the availability of data collected by the state maternal mortality and morbidity review committee; and the availability, affordability, and adequacy of insurance coverage relative to prenatal and post-partum care. The commission would be tasked with developing a report of its findings, recommendations, and drafts of legislation necessary to carry those recommendation into effect.

Legislation that facilitates collection and review of maternal mortality data could help state health agencies, stakeholders, and policymakers better understand the underlying causes of maternal deaths and health disparities. The use of this data will also inform evidence-based or evidence-informed policies to improve maternal health outcomes. ASTHO will continue to monitor legislative activity around this important public health issue.