Preventable Maternal Deaths Continue to Occur in the U.S.
Cross-sector partnerships needed to address contributing factors
Pregnancy-related deaths among American women have risen markedly over the past 30 years, despite an overall downward trend worldwide. Many of these deaths are preventable, and the risk remains three to four times higher for black women than white women at all levels of income or education.
Maternal mortality—a key measure of health care quality—is typically defined as the death of a woman during or after a pregnancy from any cause related to or aggravated by the pregnancy or its management. Research reveals that more than 60 percent of these deaths are preventable. It also shows that racial disparities exist for multiple reasons, but many of those factors can be addressed if health care systems improve care quality and access and partner with other societal sectors, such as educational and community organizations.
Some states are tackling the national problem through innovative initiatives anchored in shared action and accountability. For example, California launched the California Maternal Quality Care Collaborative in 2006. That effort mobilized multiple health care systems to create data-sharing practices and protocols that could help reduce maternal mortality rates. And the rates in the state declined 55 percent from that year to 2013.
But maternal mortality disparities, notably for African American women compared with all other races, persisted. To address this reality, the collaborative extended its reach in 2019 to include black women-led, community-based organizations, hospitals, and experts by forming the California Birth Equity Collaborative, which is focused on improving birth outcomes for black women.
The broad range of factors beyond the quality of medical care that can contribute to the problem presents significant challenges in addressing maternal mortality. Those factors include gaps in post-birth support and access to care, transportation, housing, education, and other social determinants of health. Finding solutions therefore requires partnerships across various sectors.
To help address these issues, the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts, is supporting state-level agencies and community partner organizations across the country in identifying and implementing strategies to improve infant and maternal health. By combining expertise and resources across multiple agencies—including those not traditionally involved in public health—these states can more effectively address the many drivers of maternal and infant well-being and begin closing outcome gaps among demographic groups.
Currently, this initiative to improve maternal health is underway in Colorado, Kansas, Louisiana, Michigan, Minnesota, Mississippi, New Jersey, Virginia, Washington, and the District of Columbia. The leadership structures, skills, and lessons gained from this work will give the governments a blueprint for future interagency strategies that can address a range of challenges.
Elsewhere, the University of Maryland, Baltimore (UMB) recently highlighted the cross-sector approach in its winning submission in the National Academy of Medicine’s annual D.C. Public Health Case Challenge this fall.
The UMB proposal for improving maternal health in the Washington, D.C., area included creating a network of doulas, community health workers, and peer community coaches to promote women’s health in underserved areas. As part of the effort, community organizers would build a coalition of community members, leaders, and providers to create support for reimbursement of birth doula services from Medicaid and private payers, as well as for paid maternity/paternity leave.
Each preventable death is tragic, and every effort should be made to eliminate maternal mortality where possible. Research and data confirm the impact of a range of social determinants of health on maternal deaths. That’s why it’s important that policymakers and community leaders encourage collaborative efforts that look well beyond health care systems.
Stacey Millett directs the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts.