United States

• The maternal mortality rate in the United States has significantly increased from 7.2 deaths in 1987 to 16.7 deaths in 2016.
• Approximately 700 women die each year as a result of pregnancy or complications related to pregnancy.
• For every maternal death, there are also over 80 women who suffer from maternal morbidity, totaling over 55,000 severe complications in 2014.
• Pre-existing conditions, rather than complications with delivery, have now become the leading cause of maternal mortality and morbidity, with cardiovascular conditions being responsible for 33.6% of pregnancy-related deaths.
• Nationally, over 60% of maternal deaths could have been prevented. A Tennessee report issued this year found an overwhelming 85% of its maternal deaths could have been prevented.

Alabama

• In 2017, 41 women died from pregnancy or childbirth complications, the second-worst maternal death of any state in the nation that year.
• From 2011-2015, the maternal mortality rate for White women was 5.6%, while the rate for Black women was 27.6%. However, due to newly available statistics and reporting, these numbers are projected to be much higher today.
• Alabama’s maternal death rate is increasing, with only 12 deaths in 2015, then 35 in 2016, to 41 in 2017.
• Around 60% of maternal deaths in Alabama occur after delivery, not before.
• Nearly 65% of Alabama mothers reported having some kind of medical problem during pregnancy.
• Alabama ranks 46th in women’s and children’s health, and Alabama’s hospitals rank 47th in maternity care and infant feeding.
• Fewer than 50% of Alabama counties now have a hospital with obstetrical services.

Black Women

• Overall, women of color accounted for 40.7% of all US live births, but experienced 61.8%
  of the 7,487 pregnancy-related deaths from 1993 to 2006.
• Nationally, Black women are 3-4x more likely to die from pregnancy-related issues than White women.
• From 2011-2016 the pregnancy-related mortality ration was 42.4 deaths per 100,000 live births for black women, and only 13.0 deaths per 100,000 live births for white women.
• Even Black women with more education and higher incomes still die at a higher rate. Among all women with a college education, Black women are 5.2x more likely to die than their White counterparts.
• In 2010, 32% of Black women did not receive the recommended number of prenatal visits, an increase in 7% of the national average.
• In 2016, the preterm birth rate for Black women was 50% higher than White women.

Rural Health Challenges 

• A lack of access to high-quality maternal health services in rural communities is the result of many
  factors including hospital and obstetric department closures, workforce shortages, and access to care
  challenges arising from the social determinants of health which have contributed to disparities in
  maternal health care for rural women and their babies.
• Between 2004 and 2014, 179 rural counties lost or closed their hospital obstetric services. Consequentially, fewer than 50% of rural women have access to perinatal services within a 30-mile drive from their home and more than 10% of rural women drive 100 miles or more for these services.
• In Dallas County, Alabama, where many obstetrical care providers have closed, and there is no meaningful public transit infrastructure. Because of this, a recent report describes how some Selma residents have no other choice than to pay friends or family to drive them to a clinic.

Rural Health Statistics

• Maternal mortality rates are significantly higher in rural areas than in urban areas. For 2015, the maternal mortality rate for rural women was 29.4%, whereas in large metropolitan areas it was 18.2%.
• One in five Americans live in a rural community, including approximately 18 million women of reproductive age, and nearly half a million babies are born in rural hospitals each year.

Overview of MMRCs

• The overall purpose of the MMRC is to: Conduct reviews of each maternal death; Create actionable prevention strategies; Implement positive changes in health systems; Reduce maternal mortality and complications; and Improve health for women, infants, and families.
• Today, at least 35 states have an established committee and process to review maternal deaths.
• Slightly more than half the states have maternal mortality review committees that have been operating for at least a year. Many receive little or no funding and rely on volunteers to take on case analyses.
• For each case, they typically extract demographic data such as a woman’s age and race, then use medical records, notes from care providers and other resources to look at what happened, determining whether the catastrophic outcome was related to pregnancy or childbirth and whether it was preventable.
• Using the data gathered, MMRCs are optimized when they provide recommendations and develop strategies to prevent problems that arise during the prenatal and postpartum period.

Alabama’s MMRC

• In 2018, a coalition of Alabama doctors, nurses, public health leaders and others began forming a Maternal Mortality Review Committee under the umbrella of the Alabama Department of Public Health. The committee met to review its first cases in February of 2019. 
• Alabama funds programs to review infant deaths, but its MMRC currently receives no funding. As a result, ADPH must rely on staff and volunteers from other programs and professions in order to compile data and review maternal deaths.
• The CDC funds some state MMRCs through a grant program, but funding is only provided to MMRCs that have been meeting for at least 12 months. Thus, Alabama was not eligible for federal funding.

Racial Disparities

• Reducing disparities in maternal mortality requires addressing multifaceted contributors. Ensuring robust comprehensive data collection and analysis through maternal mortality review committees offers the best opportunity for identifying priority strategies to reduce disparities in pregnancy-related deaths.

MMRC Success

• Since creating its MMRC and implementing new policy and system strategies, California reduced its maternal mortality rate by half to an average of 7 deaths per 100,000 births.
• Not only has California’s MMRC reduced maternal mortality overall, but the most significant reduction in deaths was among Black women.
• North Carolina’s MMRC has contributed to improved outcomes and a reduced maternal mortality rate among Black women, so much so that its racial disparity has become non-existent. 

Alabama Healthcare

• “When a mom dies, it is such a tragic event that impacts not only the baby but a whole family. It’s a reflection on the quality of healthcare here in our state. It’s a failure of our healthcare system when that happens. We’ve got to do better.” -Dr. Grace Thomas, OB-GYN, Health Officer for Family Services at ADPH

Racial Disparities

• “We know that black women are much more likely to die in childbirth. We know black babies are more likely to die than white babies. But we don’t understand the why, and I don’t think we’ve done enough to address the issue adequately.” – Dr. Sara Mazzoni, Associate Professor, Dept. of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine.

Funding the MMRC

• “As an organization of physicians, we feel compelled to take the lead in tackling this issue. Each and every maternal death is devastating to families, and leaves everyone asking ‘why?’.  Alabama’s maternal mortality stats are unnerving. As physicians, we feel like our state has got to do better, can do better, and must do better, and our coalition partners feel the same way.  But until we have a thorough review of the maternal death data, we can’t answer the all-important question of ‘why?’ when a mother dies and take steps to stop maternal death.  Alabama has made major strides in reducing infant mortality in large part due to action steps identified through the state’s infant-death review process.  But Alabama currently doesn’t fund maternal mortality review, and until we appropriately do so and dig down into the root causes of maternal death in this state, we can’t expect to be able to make informed health policy decisions as a state to move forward in eradicating maternal deaths.” – Dr. John Meigs, President of the Medical Association of the State of Alabama