By Keisher Highsmith, DrPH
Director, Special Initiatives & Program Planning & Evaluation, Division of Healthy Start and Perinatal Services, Maternal and Child Health Bureau, Health Resources and Services Administration; Project Director for the Maternal Health Initiative and the Alliance for Innovation on Maternal Health: Improving Maternal Health and Safety initiative
The rising number of maternal deaths and severe complications in the United States is an indicator of the fragmented public health and health care delivery system. The CDC reports that severe maternal morbidities have risen 50 percent in the last decade, from 7.2 to 17.8 per 100,000 live births, and estimates that 50 percent of maternal deaths are preventable. New birth certificate data (2013) show that rates of maternal morbidity were higher for cesarean than vaginal deliveries. Blood transfusion and ICU admissions were the highest among women who had a primary cesarean delivery; 525.1 and 383.1 per 100,000 live births, respectively. Significant race and ethnic disparities in maternal mortality persist and have not improved in more than 60 years. In the United States, African American women have a three to four times higher risk of dying from pregnancy-related complications than white women. In some states, this risk is as much as six to seven times higher for African American women compared to white women.
In recent years, efforts to reduce maternal morbidity and mortality have reemerged to address policy, clinical practice, surveillance and research. In 2011, the Health Resources and Services Administration (HRSA) announced its commitment to improving women's health by launching the Maternal Health Initiative, a national strategy to reduce maternal morbidity and mortality. In September 2014, to take action toward this national vision, HRSA launched the Alliance for Innovation on Maternal Health: Improving Maternal Health and Safety (AIM: Maternal Health), a national campaign to equip and empower every state, perinatal quality collaborative, hospital network/system, birth facility and maternity care provider in the United States to save women from mortality and preventable severe complications during pregnancy, labor and delivery. This will be achieved by collaborating with states and hospital systems across the nation to promote a culture of maternal safety through three primary strategies: 1) developing evidence-based patient safety bundles to reduce low-risk primary cesarean deliveries; 2) integrating maternity safety practices into birthing facilities for the three most preventable causes of maternal death: obstetric hemorrhage, severe hypertension and venous thromboembolism; and 3) promoting preconception/interconception care and utilizing postpartum and well-women visits to provide such care.
The AIM: Maternal Health is designed to complement current maternal safety initiatives in progress on a state and hospital level through:
- Alignment of national, state, and hospital level efforts to improve maternal health and safety
- Integration of system based improvement initiatives to reduce adverse maternal outcomes
- Harmonization of data-driven continuous quality improvement processes
- Access to evidence-based implementation resources to streamline maternal safety bundle implementation
The AIM: Maternal Health is a national coordinated effort of maternity provider and hospital organizations, public health groups, and women's support and advocacy organizations including: the American College of Obstetricians and Gynecologists (ACOG), American College of Nurse Midwives (ACNM), AMCHP, Association of State and Territorial Health Officials (ASTHO), Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN), California Maternal Quality Care Collaborative (CMQCC), Society of Maternal-Fetal Medicine (SMFM), and the Council for Patient Safety in Women's Health Care. Furthermore, HRSA also partnered with government agencies including: the Centers for Disease Control and Prevention (CDC), Agency for Healthcare Research and Quality (AHRQ), Centers for Medicare and Medicaid Services (CMS), the Indian Health Service (IHS), and the Department of Defense (DOD).
Quality improvement and practice change requires engagement of many partners, hard work and local ownership. AIM: Maternal Health provides important support for this process and works with states to design a plan that complements existing efforts and strengthens both the public health and health care delivery systems. To learn more about the Maternal Health Initiative, please visit http://mchb.hrsa.gov/maternalhealth/. To learn more about the Alliance for Innovation on Maternal Health: Improving Maternal Health and Safety campaign, please visit http://www.safehealthcareforeverywoman.org/aim.html.