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. 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. Even more concerning are reports that U.S. maternal mortality rates may be rising and disparities between racial groups widening. 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, the AMCHP Every Mother Initiative launched in 2013 to help states take specific and focused steps to reduce maternal mortality and maternal morbidity. The core element of the initiative are two Action Learning Collaboratives comprising two cohorts of six states. ALCs are multidisciplinary learning communities that analyze a public health problem and implement program and policy solutions. Each cohort of six states works together over a 15-month period to strengthen their
state-based maternal mortality review process and ensure the efforts of
their reviews to characterize the factors contributing to maternal deaths lead to data-informed and effective population-based strategies
to prevent their further occurrence. Participation in the ALC includes 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 of the initiative, which ran from August 2013 through October 2014, included Colorado, Delaware, Georgia, New York, North Carolina, and Ohio. Translation projects selected by the first cohort included topics and methods such as qualitative interviews with women to build systems-level interventions for pregnancy-associated deaths due to substance overdose, suicide, and intimate partner violence; development of a maternal transport nursing course; implementation of a referral protocol for women to a family planning clinic from high-risk clinics; translation of hypertensive disorders of pregnancy guidelines into usable provider and patient tools; development of public service announcements for a cardiovascular disease social marketing campaign; and implementation of simulation exercises in pilot Level I and II birthing facilities. Publications and case studies of lessons learned from the first cohort are forthcoming.
In October 2014, AMCHP announed the second cohort of the Every Mother Initiative, which will build on the successes of the first cohort and engage them as mentors in their own translation efforts. The six teams selected for the second cohort, with MCH leaders at the helm, include: Florida, Illinois, Louisiana, Missouri, Oklahoma, and Utah. The ALC will run from October 1, 2014 through December 31, 2015. State teams were selected from a competitive Request for Application (RFA) process. To view the RFA, please click here: EveryMotherRFACohort2_FINAL.pdf
States Participating in the Every Mother Initiative
Cohort 1: CO, DE, GA, NY, NC, OH; Cohort 2: FL, IL, LA, MO, OK, UT
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.
World Health Organization, 2010. Trends in maternal mortality: 1990 –
2008, estimates developed by WHO, UNICEF, UNFPA, and The World Bank.
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.
 Amnesty International, 2010. Deadly delivery: The maternal health care crisis in the USA. London, UK