• Maternal deaths are a national tragedy that deserve a national response

    Katy Kozhimannil, PhD, MPA is Director of Research at the University of Minnesota Rural Health Research Center and an Associate Professor in the Division of Health Policy and Management, University of Minnesota School of Public Health. You can follow her on Twitter at @katybkoz.

    In a recent column, aptly titled “If Americans Love Moms, Why Do We Let Them Die?” New York Times columnist Nick Kristof states that “we’ve structured health care so that motherhood is far more deadly in the United States than in other advanced countries,” and cites data showing that an American woman is five times as likely as a British woman to die around the time of childbirth.

    In the U.S., maternal mortality has doubled over the past two decades. This has occurred during a time when almost all other developed and developing countries in the world have seen declines.  Our high rates of maternal mortality and recent increasing trends have been called a national embarrassment. What’s more troubling still is the staggering racial inequities in maternal mortality. The CDC’s data show pregnancy-related mortality of 12.7 deaths per 100,000 live births for white women, which is shockingly high compared with other countries.  Black women have nearly four times the risk of death around the time of childbirth.  The pregnancy-related mortality rate is 43.5 deaths per 100,000 live births for black women in the US.

    The top journal for obstetricians, Obstetrics and Gynecology, recently published a perspective article by Dr. Steven Clark and Dr. Michael Belfort. These two highly respected obstetricians and seasoned researchers have spent their careers studying maternal mortality, and they argue the case for establishing a national maternal mortality review committee in the United States. It is both a public health and equity imperative to establish such a committee.

    The authors point to examples from other developed countries, including a recent surveillance report from the UK’s national maternal mortality tracking system, which have helpfully informed public health and clinical efforts to reduce maternal mortality. The call by Drs. Clark and Belfort builds upon CDC efforts and a recent Health Affairs Blog by Assistant Surgeon General Dr. Wanda Barfield highlights the many efforts underway, but these efforts need greater structure, resources, and consistency across settings.

    About half of all states have maternal mortality review committees.  I have served on Minnesota’s committee since 2012.  We spend hours and hours reviewing each maternal death, assessing preventability and making recommendations. To my knowledge the data from our work has never been publicly released, and our numbers are too small for meaningful statistical estimates.  Serving on this committee is emotionally difficult, to be sure, but it’s frankly heartbreaking to know that our work (and the tragedies we review) have little influence on the rising tide of maternal mortality.

    As a member of Minnesota’s maternal mortality review committee, I am familiar with the CDC’s newly-launched MMRIA data system, and while this is a step in the right direction, it still falls short: data are not collected across all states, are not collated or integrated for analysis, and are not easily available for states or researchers to study patterns.

    The Obstetrics and Gynecology article notes the need for federal guidance and support in creating a functional national maternal mortality review committee, as infrastructure and data differ dramatically across states.  Drs. Clark and Belfort state: “The establishment of such a committee would in fact probably quite literally take an act of Congress to effectively deal with issues of funding, privacy, and legal liability. However, unless we are to be satisfied with another decade of hand-wringing and strident calls to action, we cannot imagine anything more likely to be actually effective than the establishment of such a committee.”

    In July 2017, I wrote to the CDC’s Division of Reproductive Health about this issue, and I received a prompt response highlighting the importance of state and local efforts, as well as the CDC’s efforts to support regional approaches for rural and smaller states to work together. The response also noted the crucial role of data availability on maternal deaths in the US, citing the “ultimate aim of having robust, national data to improve maternal outcomes and eliminate preventable maternal deaths.”

    Yet, it stopped short of offering support for a national maternal mortality review committee.  Perhaps the current political climate hampers feasibility, with a focus on greater local control and flexibility.  But our current trajectory makes it clear that’s not enough.

    Recent media attention, including an amazing in-depth investigation of maternal deaths by Pro-Publica and NPR and a Vox.com series by Julia Belluz focusing on successes in California and North Carolina, are bringing new light to maternal mortality.

    The time is right to take national action to address this national crisis, by structuring and resourcing a federal maternal mortality review committee. Led by Senator Heidi Heitkamp (D-ND) and Senator Shelley Moore Capito (R-WV), Congress is taking the first steps toward creating an infrastructure to reduce maternal mortality, with the 2017 Maternal Health Accountability Act (S. 1112). While it does not go as far as Drs. Clark and Belfort suggest, this bill deserves wide support and could provide a foundation on which to build a healthier future for our nation’s mothers. It’s time. We simply can’t keep bearing the needless loss of beloved moms.

    This post has been updated to add information about S. 1112.

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