Maternal Mortality Review Committees and Their Potential Impact on Maternal Mortality Rates
July 10, 2018
More women in the U.S. die from pregnancy complications than in any other developed country, and the rate of maternal deaths continues to rise. Recent legislation supports the development of a model for states to operate maternal mortality reviews and develop appropriate interventions to reduce and prevent such deaths.
More women in the United States die from pregnancy complications than in any other developed country, and the rate of maternal deaths continues to rise. From 1999 to 2014, the maternal mortality rate has skyrocketed from 9.8 deaths to 21.5 deaths per 100,000 live births. Additionally, the maternal mortality rate is worse for people of color. Black women are three to four times more likely to die from a pregnancy-associated cause than white women.
To address these alarming statistics, the Senate Appropriations committee recently requested $50 million in funding to address maternal mortality. In addition, the Senate Health, Education, Labor and Pensions committee approved the Maternal Health Accountability Act (S.1112). Introduced in 2017 with its companion House bill, the Preventing Maternal Deaths Act (H.R. 1318), the legislation seeks to bolster the development and effectiveness of Maternal Mortality Review Committees (MMRC).
Both acts propose two main objectives. First, they intend “to establish a shared responsibility between States and the Federal Government to identify opportunities for improvement in quality of care and system changes, and to educate and inform health institutions and professionals, women, and families about preventing pregnancy-related and pregnancy-associated deaths and complications and reducing disparities.” Second, they support development of “a model for States to operate maternal mortality reviews and assess the various factors that may have contributed to maternal mortality…and to develop appropriate interventions to reduce and prevent such deaths.” Additionally, the bills would:
- Create CDC grants to distribute money to states;
- Mandate confidential case reporting of pregnancy-related and pregnancy-associated death events by health care providers, hospitals, and birth centers to State health departments;
- Create a process for voluntary and confidential reporting by family members of the deceased;
- Increase identification of pregnancy-related and pregnancy-associated deaths by standardizing birth and death records;
Establish State Maternal Mortality Review Committees;
- Amend the Public Health Service Act with a new section that would improve care through research, expanded access to services, and demonstration interventions.
Under typical practices, death certificates do not accurately record pregnancy-related death information. MMRCs collect and gather that information when investigating maternal death and seek to gather additional information on each death reviewed.
Whenever possible, MMRCs present information stratified by race/ethnicity, age, and timing of death. The Report from Nine Maternal Mortality Review Committees, released in early 2018, found that pregnancy-related deaths are most common (45 percent) in the 42 days after the end of the pregnancy and were more common than pregnancy-related deaths during the pregnancy (37.6 percent). Pregnancy-related deaths were also more common among non-Hispanic black women, followed by Hispanic women, and then by non-Hispanic white women. Women over age 30 have a higher rate of pregnancy-related death than do women in their 20s and younger.
The Report from Nine Maternal Mortality Review Committees culled data from a greater number of MMRCs compared to previous years and, for the first time, made recommendations to prevent future deaths and estimated the level of impact if those recommendations were implemented. The proposed Preventing Maternal Deaths Act and Maternal Health Accountability Act will allow existing MMRCs to continue and enhance their valuable work researching, reviewing and addressing maternal mortality rates. Furthermore, the bills would expand access to resources, coordination, communication, and data to create analyses within and across race/ethnicity, age at death, cause of death and geography. As more states develop MMRCs and collect yearly data on maternal deaths, there will be opportunities to assess if recommendations for action are having a positive impact lowering the maternal mortality rate. As the Report from Nine Maternal Mortality Review Committees concludes, “each maternal death is one too many.”
An upcoming Network for Public Health Law and National Health Law Program issue brief will examine the steps MMRCs take to review maternal deaths and how they make recommendations to prevent future deaths.
This post by Daniel Young, MPH., Health Policy Fellow for the Network for Public Health Law–Southeastern Region and National Health Law Program.
The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document do not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.
Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not necessarily represent the views of, and should not be attributed to, RWJF.