By Melanie Rouse
Maternal Mortality Projects Coordinator
Virginia Department of Health
The Virginia Maternal Mortality Review Team reviews all deaths of women who were pregnant within a year of their death regardless of whether the death is related to the pregnancy or the outcome of the pregnancy. Reviewing all pregnancy-associated deaths allows the team to understand the causes of maternal death within the context of women's lives and the circumstances surrounding injury and disease patterns. (Learn about terminology in maternal mortality here.) It also provides a glimpse into the health and well-being of women of child-bearing age in general.
Exploration of pregnancy-associated deaths in Virginia shows a significant racial disparity. The pregnancy-associated mortality ratio among black women is 79.2 deaths per 100,000 live births, compared with 34.2 deaths per 100,000 live births among white women. Case reviews conducted by the team reveal significant community-, facility-, provider-, and patient-related factors that contribute to these deaths. These factors are often influenced by regional and policy issues and can vary based on race and socio-economic status.
The Virginia team routinely explores and evaluates the context within which it reviews cases to ensure that case reviews are in-depth and allow for the identification of all factors that contribute to these deaths. Recently, team members determined that incorporating a more ecological framework in the case review process would enable reviewers to understand policy and regional issues that may be present before pregnancy, and would result in more in-depth case reviews; better understanding of how and why community, patient, facility and provider-related factors contribute to these deaths; and the development of recommendations and interventions that will appropriately address these issues.
The team elected to use the reproductive justice framework because it links reproductive rights with social justice and is based on a human rights framework.* The team is exploring how this framework can be used to improve the case summaries and to guide the case review. Potential methods include highlighting the evidence related to regional issues and policies that can influence the behaviors and health care practices of pregnant women in a specific region, as well as the ways those women interact with and are treated by the health care system.
To learn more about Virginia's experiences with the reproductive justice framework, and successes and challenges with its implementation, contact Melanie Rouse at melanie.rouse@vdh.virginia.gov .
* Reproductive justice combines reproductive rights and social justice and can be defined as the right for women to maintain personal bodily autonomy, have children, not have children, and parent their children in safe and sustainable communities.