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From the President: Emerging Issues

 Developing Solutions to Reduce Maternal Mortality

Lessons from the Every Mother Initiative

By Dr. Mary-Ann Etiebet
Lead and Executive Director, Merck for Mothers

Maternal mortality is on the rise in the U.S. In fact, the country has one of worst rates of all high-income nations, and the numbers are going in the wrong direction. Recently, there has been a surge in media attention to the issue, especially the tragic stories of women dying from complications of pregnancy and childbirth. In response, citizens across the country have been asking their elected officials what they are doing to save women's lives.

Lawmakers are listening. Members of Congress on both sides of the aisle have signed on to legislation that calls for important policy changes to ensure that all women have a healthy pregnancy and safe childbirth. Legislation has been introduced in the House and Senate — particularly the Preventing Maternal Deaths Act (H.R. 1318) and the Maternal Health Accountability Act (S. 1112) — that provides support to states as they establish maternal mortality review committees (MMRCs) to understand why women are dying.

Reviewing the cases of women who have died, learning from the findings, and translating them into action is one of the most effective ways to prevent future maternal deaths. Here is some of what we've learned from efforts to establish and strengthen MMRCs. 

A Strong Start: the Every Mother Initiative

AMCHP's Every Mother Initiative (EMI) laid the foundation for helping states recognize the power of review committees to bring about sustained improvements in maternal health. Established in 2013 with support from Merck for Mothers, the EMI developed and strengthened the capacity of 12 states to review their maternal deaths, identify the root of the problem, and implement solutions to their particular challenges.

The results from the initiative, including the findings and actions of these 12 states, are highlighted in a newly published report, Making Pregnancy and Childbirth Safer in the U.S.: Insights from 12 States.

Each state developed solutions in response to their findings, and among those findings were several commonalities across the country. For example: Chronic conditions — such as diabetes, hypertension and obesity —affected many women's health during pregnancy and beyond. Support for mental health is increasingly critical to improving maternal health outcomes. And helping health care teams provide high quality care during an obstetric emergency can save lives.

Through the EMI, states strengthened their review processes and created focused interventions to address maternal mortality and morbidity. Here are some examples of how states' MMRCs used evidence to inform state-specific action:

  • Oklahoma's Maternal Mortality Review Committee identified hypertension and hemorrhage as major contributors to maternal mortality in the state. In response, a collaboration of partners from across the state designed and launched a hospital-based maternal safety quality improvement initiative. Teams from 37 hospitals implemented evidence-based practices associated with readiness, recognition, response, and reporting to improve maternal health outcomes.
  • In Florida, the state's Pregnancy-Associated Mortality Review committee found that black women were significantly more likely to die from pregnancy complications than white and Hispanic women. The team also identified the importance of promoting preconception health to address chronic conditions. Along with community partners, Florida's review committee established Preconception Peer Educator programs within three historically black colleges/universities and other state colleges. Peer educators raised awareness about preconception health, maternal mortality, and racial disparities in maternal health.

Current Efforts: Helping More States Implement Maternal Mortality Review Committees

To ensure that all states have the tools to review and act on every maternal death, AMCHP and the U.S. Centers for Disease Control and Prevention (CDC) are building the capacity of states to review maternal deaths using a standardized approach. With the Maternal Mortality Review Information Application (MMRIA), states are now able to submit their data to a CDC-based repository, getting us one step closer to a national-level understanding of maternal mortality in the U.S. and a national response.

A major milestone of the CDC's effort was the publication of a report that presented trends from nine MMRCs — the first ever multistate report on maternal mortality in this country. Pending federal legislation builds on this important contribution, calling for funding to support state-based MMRCs and the national analysis of the data states generate to guide actions that will prevent future tragedies.

Vision for the Future: Moving from Evidence to Action

Understanding why a maternal death occurred is a critical step toward preventing future tragedies. MMRCs play an important role in uncovering and addressing the reasons why women die during pregnancy and childbirth. We believe that all states should review these deaths and translate the findings into life-saving action — and it's encouraging to see the growing interest in review committees from Alabama to Wyoming.

As more states examine their maternal deaths and contribute their data for national analysis, the U.S. will be better equipped to identify trends and track progress to end preventable maternal mortality. Let's hope the pending federal legislation accelerates progress in turning the tide on maternal mortality and improving the health of the four million women who give birth in the U.S. each year.

Merck for Mothers is Merck's 10-year, $500 million initiative to help create a world where no woman dies while giving life.