According to the World Health Organization, a maternal death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. The US maternal mortality ratio (MMR) doubled between 1995 and 2008, and is 3 to 4 times higher among black women than white women. The MMR can underestimate pregnancy related deaths by 50% or more. Maternal death reviews are necessary for ensuring all deaths are identified and effective prevention actions developed.
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 will launch a new program in partnership with Merck for Mothers in May 2013. For more information about how AMCHP is involved in all these national initiatives see below.
| 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.
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- Peer-to-peer linkages between state teams
- Document and disseminate state best practices as case studied and other resources
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| 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.
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- 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
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| 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
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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.