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 Maternal Mortality and Severe Morbidity

Pregnancy-related deaths are an indicator of the overall health of women of reproductive age. While they are rare in the United States, there is evidence that rates are getting worse. African American women are three to four times as likely to die as a result of pregnancy when compared to non-Hispanic, white women [1]. Each of the 700 pregnancy-related deaths that occur annually represents a community devastated by loss. An additional 50,000 women or more experience severe complications of pregnancy each year [2]. Many are preventable. 

Transformation of the Title V MCH Services Block Grant in 2015 calls for national improvements in maternal health outcomes, including rates of severe morbidity (serious complications per 10,000 delivery hospitalizations) and maternal mortality (deaths during pregnancy or within 42 days of delivery due to pregnancy or its management, per 100,000 live births). Two of 15 National Performance Measures (NPMs) now address women's and maternal health: percent of women with a past year preventive "well woman" visit (NPM-1), and percent of cesarean deliveries among low-risk first births (NPM-2). Each state must select at least one of these measures to address with Title V funds.

Below are some of the efforts AMCHP leads or supports to help its members address these measures and make motherhood safer for women in their states.

Coming Soon! Maternal Mortality Review (MMR) Resource Portal for States

AMCHP will soon host a Web-based portal for the sharing of mortality review resources. Would you like to access templates and examples from a state near you? The portal will help you find resources to assist with legislation, case finding, data collection, review, action, and more. To submit your resources, complete this form and submit to Andria Cornell, acornell@amchp.org.

Maternal Health Resource and Planning Guide for States

Released in May 2015, Health for Every Mother offers a menu of strategies supported by examples from more than 30 states and a wealth of national program and policy resources. The guide also includes assessment tools for use internally or with partners. AMCHP staff are happy to talk with you about opportunities to use the guide in your state or community. Contact Brittany Argotsinger, bargotsinger@amchp.org, to learn more or to request a hard copy by mail.

Click here to download the full guide, optimized for web viewing. To access fillable planning forms, check back soon.Interested in promoting the guide in your state or hoping to share it with your partners? Sample social media posts and e-newsletter content can be found here.

 

AMCHP Every Mother Initiative

With support from Merck for Mothers, the AMCHP Every Mother Initiative launched in 2013 to help states take specific and focused steps to reduce maternal mortality and severe morbidity.

At its core, the Every Mother Initiative is about peer learning and mentorship. To facilitate this learning, AMCHP hosts 15-month Action Learning Collaboratives (ALCs), or multidisciplinary learning communities that come together to address a common public health issue. Every Mother ALCs aim to strengthen state maternal mortality review (MMR) capacity and support states in taking action based on MMR committee recommendations. 

Participating states join virtual learning sessions, attend site visits to peer states, and receive a translation award to fund program and policy activities. View the most recent Request for Applications here: EveryMotherRFACohort2_FINAL.pdf. Find archived application information here.

States Participating in the Every Mother Initiative ALC

Cohort 1 (August 2013 - Oct 2014): Colorado, Delaware, Georgia, New York, North Carolina, & Ohio.
Cohort 2 (October 2014 - December 2015): Florida, Illinois, Louisiana, Missouri, Oklahoma, & Utah. 

 Translation Activities

Publications and case studies from the first cohort are coming soon. The first cohort's translation successes are captured in an infographic here and reflect a range of possible ways to improve maternal health:

Colorado interviewed women with a history of substance abuse and depression to learn how stronger systems of  care could prevent pregnancy-associated deaths from these causes.

Delaware launched a maternal transport nursing course to ensure that high-risk women safely reach an appropriate level of care at time of delivery.

Georgia trained health care providers, piloted a referral protocol to link women with uncontrolled chronic conditions to family planning services, and developed complementary clinic videos and patient education materials.

New York developed patient and provider resources to translate the state's Hypertensive Disorders of Pregnancy Guidelines and improve adherence to recommendations.

North Carolina developed a social marketing campaign to encourage heart-healthy living before pregnancy.

Ohio piloted simulation training exercises to prepare clinicians in Level I and II birthing facilities across the state to respond effectively to obstetric emergencies.

 

CDC Maternal Mortality Review Data System - check back soon for updates!

On Friday, January 23, 2015, AMCHP and CDC partnered to offer an in-person, day long training on a new data system developed by CDC personnel that supports centralized, state-level analysis and leverages standard data sources for maternal death reviews. This training took place immediately prior to the 2015 AMCHP Annual Conference at the Hyatt Regency Capitol Hill in Washington, DC. For archived information on this event, click here.

Alliance for Innovation on Maternal Health (http://www.safehealthcareforeverywoman.org/aim.html)

The Alliance for Innovation on Maternal Health (AIM) is a national partnership of organizations poised to reduce severe maternal morbidity by 100,000 events and maternal mortality by 1,000 deaths by 2018. The AIM program is funded through a cooperative agreement with the Maternal and Child Health Bureau in the U.S. Health Resource Services Administration.

 

 

Assessment of State and Local Capacity for Maternal Mortality Review (2012)

In the spring of 2012, the CDC and AMCHP conducted an assessment of US state and local capacity for conducting reviews of maternal deaths. Twenty state and 2 local maternal death reviews were selected from an estimated 31 state and 3 local reviews. Reviews were selected based on evidence they were currently active and that case review was conducted by committee. CDC and AMCHP developed a 33 item online assessment, covering: funding and staffing; case identification, abstraction and review; legislation; challenges; and examples of translation.

To access a summary of assessment findings click here