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 Maternal Mortality

In the United States, pregnancy-related mortality is a rare but troubling event – data suggest approximately 1,000 women die per year (more than two women a day) due to pregnancy-related causes.[1] However, the overall rate masks the approximately 52,000 severe maternal morbidity events that occur annually. Recent estimates indicate that for every 10,000 delivery hospitalizations in the United States each year, more than 120 women experience these severe complications.[2] Even more concerning are reports that U.S. maternal mortality rates may be rising and disparities between racial groups widening.[3] Identifying cases, reviewing the factors that may have contributed to maternal deaths and analyzing and interpreting the findings to stimulate action offer an important means of improving maternal health by facilitating systems change at all levels within the state.

AMCHP Every Mother Initiative

With support from Merck for Mothers, AMCHP launched the Every Mother Initiative in 2013 to help states take specific and focused steps to reduce maternal mortality and maternal morbidity. Beginning in August 2013, six states (CO, DE, GA, NC, NY, and OH) formed multi-disciplinary teams to identify and implement strategies to strengthen and enhance their maternal mortality surveillance systems, anchored in their maternal mortality reviews, and use the data from the reviews to take action in developing and implementing population-based strategies and policy change to prevent maternal death and improve maternal health outcomes. This first cohort of the Every Mother Initiative used a 15-month Action Learning Collaborative (ALC) format. ALCs are multidisciplinary learning communities that analyze a public health problem and implement program and policy solutions. Core components of the Every Mother ALC include in-person and virtual technical assistance, peer to peer site visits between teams, and a translation support sub-award to help fund implementation of maternal mortality review recommendations. The first cohort will conclude October 2014.


Cohort 2 RFA Now Available - Applications Due August 22, 2014: This RFA is for participation in the second ALC cohort of the Every Mother Initiative, which will launch in October 2014 and conclude December 2015. The second cohort will build on the successes of the first cohort and maximize opportunities for peer learning. The six selected applicants will work together as one learning cohort, with opportunity for mentorship from states that participated in the first ALC cohort, as well as one another.

Applications are due by 11:59 pm ET, August 22, 2014. For questions about the Every Mother RFA please contact Andria Cornell at acornell@amchp.org; 202-266-3043



National Initiatives to Improve Maternal Health and Reduce Maternal Mortality

Currently, there are multiple exciting initiatives to improve maternal health and reduce maternal mortality. AMCHP is a partner in the National Maternal Health Initiative and the CDC Maternal Mortality Review Initiative. In addition, AMCHP launched a new program in partnership with Merck for Mothers in May 2013.

Title

Timeline

Lead

Partners

AMCHP Role

Summary

Products

Merck for Mothers – AMCHP Every Mother Initiative Three-year project launching in 2013 AMCHP 12 state teams, other partners Lead

The goal of the AMCHP Every Mother Initiative is to strengthen and enhance state maternal morbidity and mortality surveillance systems and use the data from these systems to take action in developing and implementing population-based strategies and policy change to prevent maternal death and improve maternal health outcomes.

  • Peer-to-peer linkages between state teams
  • Document and disseminate state best practices as case studied and other resources
National Maternal Health Initiative (NMHI) Launched December 2012 (ongoing) Maternal and Child Health Bureau, HRSA State and local representatives, consumer education members, provider education members, policy members Co-Chaired the State and Community Public Health Systems Workgroup and participates as a partner for the overall initiative

The goal of the NMHI is to reduce maternal morbidity and mortality by improving women’s health across the life course and by ensuring high quality and safety of maternity care. The initiative includes five priority areas: women’s health, public awareness, state and community public health systems, quality and safety of clinical care, and surveillance and research.

  • Action Plans focused on both accomplishments that could be achieved in 6-12 months as well as 5-year goals
  • A national maternal health strategy to be launched in May
CDC Maternal Mortality Initiative (MMI) Late 2012 (first team meeting November 2012)-2013 Division of Reproductive Health, CDC 15 review teams (14 states, 1 city), CDC/DRH, HRSA/MCHB, AMCHP, ACOG, ASTHO, AWHONN, NAPHSIS, Merck for Mothers, SMFM Partnered to conduct an assessment of US capacity for conducting maternal death reviews Provides organization and facilitation support.
The goal of the MMI is to develop recommendations and standards to strengthen existing or to guide new maternal death review processes.
  • Guidelines for conducting the maternal mortality review process
  • Standardized information across reviews
  • Catalog of data to action review findings

State and Local Capacity for Maternal Mortality Assessment (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

 

 

 

 

AMCHP and Partner Resources on Maternal Mortality 

                                       

 
2012 AMCHP Conference Session "Revival of a Core Public Health Function: State-Based Maternal Mortality Surveillance"

 To access a full recording of this session click here

 

                                                


2011 ACOG State Legislative Toolkit: 
Improving Pregnancy Outcomes: Maternal Mortality Reviews and Standardized Reporting

To access the toolkit click here.
 

 

 

  

                                                

Strategies to Reduce Pregnancy-Related Deaths From Identification and Review to Action 

This manual describes strategies for conducting pregnancy-related or maternal mortality surveillance in the United States.This manual addresses issues and tasks that are important for health departments, clinicians, vital statistics personnel, pregnancy-related mortality review committees, legislators, and community groups. To access this resource click here.

 

  

 

                                                
State Maternal Mortality Review: Accomplishments of Nine States

In 2001, the Centers for Disease Control and Prevention’s Division of Reproductive Health (CDC/DRH), the Health Resources and Services Administration’s Maternal and Child Health Bureau (HRSA/MCHB), and AMCHP formed a Safe Motherhood Partnership to help states develop coordinated approaches to promote and enhance women’s health before,during, and after pregnancy. In September 2003, the Safe Motherhood Partnership, along with the American College of Obstetricians and Gynecologists (ACOG), sponsored a 2-day Invitational Meeting on State Maternal Mortality Review for nine selected states with active maternal mortality review (MMR) committees.  State Maternal Mortality Review: Accomplishments of Nine States provides real-life examples and experiences of nine states related to the MMR process in the areas of 1) MMR committee structure, organization, and composition; 2) data collection;3) dissemination and implementation of findings; and 4) guidelines for improving MMR programs. It also includes guidelines for starting an MMR, explains why state-based MMRs are useful, and provides appendices of supporting and sample documents. The information presented in this publication will benefit states with all levels of expertise and experience in MMR. To access a summary of assessment findings click here.   


[1] World Health Organization, 2010. Trends in maternal mortality: 1990 – 2008, estimates developed by WHO, UNICEF, UNFPA, and The World Bank. Geneva, Switzerland.

[2] Callaghan, WM, Creanga, AA, Kuklina, EV, 2012. Severe maternal morbidity among delivery and postpartum hospitalizations in the United States. Obstetrics & Gynecology, 120(5), 1029-36.

[3] Amnesty International, 2010. Deadly delivery: The maternal health care crisis in the USA. London, UK