Jan 2020: Maternal Mortality Congressional Meeting & New Rates Reported (Using Death Certificates)
Joy Burkhard, MBA
By Joy Burkhard, MBA, Mom Congress
Congress Talks MM
Tuesday, The House of Representatives Education & Labor Subcommittee on Health, Employment, Labor, and Pensions (“HELP committee”) convened a hearing to discuss the state of maternal and infant mortality in the U.S. and explore potential policy solutions. Members heard from an expert panel of witnesses including the Executive Director of the March of Dimes, with a demonstrated understanding of both maternal mortality more broadly, and the particular experience of minority populations.
Have 1 minute? Watch Congresswoman Underwood’s compelling opening remarks here.
Have 3 hours? Watch the full hearing recording here.
New “Vital Statistics” Report Released
Today, January 30, 2020, the Centers for Disease Control’s (CDC) National Center for Health Statistics (NCHS) released its “vital statistics” data on maternal mortality for 2018, along with other mortality indicators (e.g. infant mortality, leading causes of death, life expectancy). This was the first time the NCHS released maternal mortality data since 2007.
The report uses death certificate data and explains that a pregnancy checkbox was widely adopted in states on death certificates allowing better reporting of maternal mortality rates.
The report found the average rate was 17.4 deaths per 100,000 live births. The rate among Black women was more than twice the average.
These statistics differ from those shared by another division of the CDC (Division of Reproductive Health), as the gold standard for determining maternal mortality rates is not the use of death certificate data but intensive case review offered through state maternal mortality review committees. If state committees follow CDC guidelines, states can adequately determine maternal suicide rates too.
The CDC’s Maternal Mortality Prevention Team and the Division of Reproductive Health drafted the following message pointing out the limitations of using death certificate data as the sole source of data/review and why the CDC is promoting state-level Maternal Mortality Review Committee analyses and reporting.
The Challenges of Vital Statistics:
Vital statistics are critically important in tracking death events, overall. Information from vital statistics helps to track two measures of maternal mortality in the United States.
The maternal mortality rate (deaths during pregnancy or within 42 days after the end of pregnancy, reported by CDC’s National Center for Health Statistics), and;
The pregnancy-related mortality ratio (deaths that occur during pregnancy or within one year of the end of pregnancy, reported by CDC’s Division of Reproductive Health).
CDC initiated the Pregnancy Mortality Surveillance System (PMSS) to track pregnancy-related mortality in 1986 because more clinical information was needed to fill data gaps about causes of maternal death.
Currently, PMSS captures the most accurate accounting of deaths related to pregnancy in the United States because maternal death information from vital statistics is linked to birth/fetal death records and is interpreted clinically by medically trained epidemiologists to determine if the death was pregnancy-related.
Data from PMSS has indicated that the pregnancy-related mortality ratio has been relatively stable over the past several years. However, the risk of death from pregnancy complications during and within one year of pregnancy remains too high.
However, PMSS still relies on vital records as the primary source of information and hence there remain issues around validity, accuracy and incomplete recording about the cause of death.
CDC has been working to get better data on maternal deaths. For example, as a part of a wider effort to enhance the collection of vital statistics data, a pregnancy checkbox was suggested to be added to death certificates in 2003 in an effort to better capture these deaths. This has resulted, however, in some challenges because clinical circumstances may not be considered when using the checkbox to designate the death as maternal. Additionally, pilot validation efforts showed that the checkbox was incorrectly assigned 30% of the time.
The Importance of Maternal Mortality Review [Committees]
Because of the challenges with tracking pregnancy-related deaths using vital statistics alone, CDC is working with state and local Maternal Mortality Review Committees to strengthen and standardize their efforts on case identification and review.
Review Committees have access to multiple sources of information that provide a deeper understanding of the circumstances surrounding each death in order to develop actionable recommendations to prevent future deaths.
In 2019, CDC made 24 awards, supporting 25 states, for the Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE MM) Program. This funding directly supports agencies and organizations that coordinate and manage Maternal Mortality Review Committees to identify, review, and characterize maternal deaths; and identify prevention opportunities.
Further work remains to establish sustainable, fully functional Review Committees in every state that collects. But, increasingly, states with established Review Committees are using CDC’s standardized data system, which can bring together data across jurisdictions, improving the data not only at the state level, but also throughout the country.
As more states improve the standardization of their review process, the data will improve. Over time this will lead to comprehensive data on maternal mortality in the U.S. that will garner recommendations for prevention from committees that can point the way to eliminating preventable maternal mortality in the U.S.
It is important that we improve surveillance to ensure timely and accurate data on pregnancy-related deaths and that we take action, based on the best data available, to prevent future deaths.
Review the full report here.