By: Valerie Newberg
Despite advances in technology and policy substantially decreasing the risk of deaths associated with pregnancy in the 20th century, the U.S. is one of only a few countries with significant increases in maternal mortality in the 21st century.
The Centers for Disease Control and Prevention defines an instance of maternal mortality as a person dying during pregnancy or within 42 days of pregnancy from a cause that was not accidental or incidental. Maternal mortality is used by the World Health Organization to quantify the concept of maternal health and reflects the economic, social and public health conditions of mothers in a population. Maternal mortality also provides insight on disparities in care. The United States lags other developed nations, ranking 46th globally. Current data on maternal health, while imperfect, paints a troubling picture of inequity across American racial and ethnic groups, regions and states. The Department of Health and Human Services reports that Black and Indigenous Americans are 2-3 times more likely than white Americans to experience pregnancy-related mortality and rural mothers are increasingly likely to suffer from pregnancy-related morbidity and mortality due to decreases in rural hospital access. Maternal mortality rates are highly variable among the states. California has a rate of 10.2 maternal deaths per 100,000 live births, just half of the U.S. average. Alabama currently has a rate of 36.2.
Despite these challenges, there is reason for hope: many instances of maternal mortality and morbidity are preventable when medical professionals have the resources to provide care before, during and after a pregnancy. Additionally, the Biden administration released its “White House Blueprint for Addressing the Maternal Health Crisis,” which includes a request for a $470 million budget to develop much-needed tools that will help states and local communities mitigate this issue. The blueprint aims at “cutting the rates of maternal mortality and morbidity, reducing the disparities in maternal health outcomes, and improving the overall experience of pregnancy, birth, and postpartum for people across the country.” The plan also makes clear that reforming the American maternal health system cannot be the burden of one person, agency or institution alone. Efforts must reflect collaboration between the federal and state governments to be truly effective and equitable.
As outlined in the blueprint, the federal government is taking several steps to help states improve pregnancy outcomes.
Increasing data collection efforts
- The Centers for Disease Control and Prevention Levels of Care Assessment Tool creates “standardized assessments” of maternal care levels for policymakers in participating states.
- A review of Women, Infants, and Children participation and maternal health outcomes will provide state policymakers with robust information on the risk factors for maternal mortality and extreme morbidity.
Using equity as a guiding principle.
- Expansion of the Nurse Corps and Community Health Worker Training Program will bridge gaps in care for medically underserved communities, including rural areas, by providing additional resources for Health Professional Shortage Areas.
- Revision of guidelines will ensure rural and Indian Health Service medical facilities are prepared to care for pregnant people and mothers, even if those facilities do not have obstetric units.
- Utilization of self-monitored blood pressure regulation programs will assist those at risk for hypertensive disorders, which disproportionately impact pregnant people over 35 and Black and Indigenous mothers.
Encouraging state innovation.
- A Maternal Health Taskforce will focus on state-level data collection on maternal mortality and morbidity.
- The allocation of $9 million in new funding will support the integration of the State Maternal Health Innovation and Data Capacity Program in six more states.
- The American Rescue Plan Act of 2021 provides a Medicaid expansion pathway option through the State Amendment Plan to guarantee Medicaid and Child Health Insurance Plan coverage for mothers 12 months postpartum, rather than the 60 days required under the Affordable Care Act.
Potential options for state responses include expanding current programs to promote equity and implementing an all-government approach that incorporates several agencies and programs.
- In Arkansas, the governor proposed initiatives expanding Medicaid-eligible pregnancy benefits to include home visits for those at high-risk for pregnancy complications and coverage for mothers who earn up to 212% of the federal poverty level.
- In Delaware, lawmakers passed a bill requiring doula services be covered under Medicaid. At-risk populations not receiving doula care are twice as likely to suffer from pregnancy complications as those with doula care. Those receiving doula care covered by Medicaid report lower levels of C-sections and premature birth.
- In Nevada, lawmakers passed a bill revising the responsibilities of the Maternal Mortality Review Committee to include collaboration with the Advisory Committee of the Office of Minority Health and Equity of the Department of Health and Human Services, a practice that allows the committee to better analyze racial, age and geographic disparities in maternal care.
As the Sept. 30 deadline for Congress to pass appropriations bills approaches, the Blueprint for Addressing the Maternal Health Crisis remains a valuable opportunity for Congress to prioritize state-federal partnerships. In the meantime, states have several options in place to address disparities in maternal health outcomes, including expanded Medicaid coverage, updated data collection and more comprehensive monitoring guidelines.
- The Commonwealth Fund: Tracking State Policies to Improve Maternal Health Outcomes
- The Harvard Chan School’s Center of Excellence in Maternal and Child Health: Maternal Health in the United States