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New Maternal Mortality Statistics Highlight the Need for Alabama to Take Action

New Maternal Mortality Statistics Highlight the Need for Alabama to Take Action

Largely due to the slow implementation of a standardized death certificate by states, data on maternal deaths has not been reported on the National Vital Statistics System since 2007. Meaning that, for over a decade, the United States has not recorded an official count of pregnancy-related fatalities, nor an official maternal mortality rate. 

This year, however, we finally got a look at the numbers and, to the surprise of no one, they aren’t good.

The biggest takeaway is that the way we record deaths still isn’t very reliable and, for the second time in less than twenty years, the government is reformatting the death certificate.

Still, the government’s findings (separated by three separate formulas and spanning over sixty pages) help to shed light on the current maternal mortality crisis. Whatever statistical issues there might be, the data conclusively shows that the rate of pregnancy-related deaths has increased substantially over the past decade.

In total, 658 women were identified as having died from pregnancy-related causes (during pregnancy, at birth, or within 42 days after birth) in 2018 – resulting in a maternal mortality rate of 17.4 deaths per 100,000 live births. These numbers place the U.S. in dead last among similar, developed countries.

Even more appalling are the stark disparities in maternal deaths of black women. Specifically, the maternal mortality rate for black women (37.1 deaths per 100,000 live births) was 2.5 times that of white women (14.7 deaths per 100,000 live births) and 3.1 times that of Hispanic women (11.8 deaths per 100,000 live births).

Significant disparities also exist among different age groups, with the maternal mortality rate of women 40 and older nearly 8 times (81.9 deaths per 100,000 live births) that of women under 25 (10.6 deaths per 100,000 live births).

Unfortunately, the numbers for Alabama are much worse. In fact, with 36.4 deaths per 100,000 live births, Alabama’s maternal mortality rate is more than double that of the national average. And since the state figures are merely a top-line summary, there’s no telling what the numbers are if you were to separate by race and age.

In our state, “becoming a mother can turn into a life-or-death situation,” said Dr. Grace Thomas, assistant state health officer for family services at the Alabama Department of Public Health. “It’s a failure of our healthcare system when that happens. We’ve got to do better.”

The good news? Alabama is working to do better.

Just last year, a coalition of Alabama doctors, nurses, public health leaders and others began forming a Maternal Mortality Review Committee (MMRC) under the umbrella of the Alabama Department of Public Health (ADPH) to get a deeper look at why mothers are dying and what we can do about it.

But volunteers can only do so much, and the MMRC lacks the funding for staff and supplies in order to properly review each death. We’re trying to change that.

Right now, the Medical Association of the State of Alabama – along with other stakeholders like March of Dimes, the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and Johnson and Johnson – is spearheading an advocacy effort to bring attention to the issue of maternal mortality and see to it that the legislature provides ADPH with the resources it needs for the MMRC to be successful.

Dr. John Meigs, President of the Medical Association of Alabama, believes the MMRC, if properly funded, can reduce maternal mortality in a way similar to that of the initiatives ADPH has had in place on infant mortality – Alabama’s infant mortality rate was the lowest ever recorded in 2019.

“Ultimately, 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,” said Dr. Meigs. “But Alabama currently doesn’t fund maternal mortality review, and until we appropriately do so we can’t expect to be able to make informed health policy decisions as a state to move forward in eradicating maternal deaths.”

In other states, a funded MMRC has helped decrease the maternal mortality rate by over fifty percent. For only $478,000 (the amount ADPH requested for the MMRC in its budget), Alabama might be able to do the same.

Find out more about Alabama’s maternal mortality crisis and how you can join our campaign to Save Alabama Moms at alabamamedicine.org/savealmoms

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Alabama medical experts ask for $478,000 to investigate pregnancy-related deaths

Alabama medical experts ask for $478,000 to investigate pregnancy-related deaths

 AL.com – Anna Claire Vollers

In the wake of increased attention to a rising maternal death rate, a growing chorus is calling on Alabama to investigate the deaths of mothers from pregnancy and childbirth complications.

“Each and every maternal death is devastating to families, and leaves everyone asking ‘why?’” said Dr. John Meigs, president of the Medical Association of the State of Alabama, in a statement. “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.”

In recent weeks, the Alabama Department of Public Health asked Gov. Kay Ivey for $478,000 to better investigate why Alabama mothers are dying from pregnancy and childbirth complications.

If the request makes it into the governor’s state budget recommendation, then the Medical Association, the nonprofit March of Dimes and consumer giant Johnson & Johnson are gearing up to push for the funding in the upcoming legislative session.

In states like Texas and Tennessee, efforts to investigate maternal deaths have found most of the deaths could have been prevented. Investigations in states like California and North Carolina led to changes in healthcare and services provided to mothers.

Alabama doesn’t really know why mothers are dying from childbirth and pregnancy complications. Or even how many.

“But until we have a thorough review of the maternal death data, we can’t answer the all-important question of ‘why?’ and take steps to stop maternal deaths,” said Meigs.

Officially, 41 mothers died from pregnancy or childbirth complications in 2017, according to death certificate data reported by the state. It’s the highest number of deaths related to childbirth and pregnancy that Alabama has recorded in recent years.

But using just the death certificate data has been shown to be unreliable. The U.S. Centers for Disease Control and Prevention doesn’t recommend using those numbers alone to get an accurate count of maternal deaths.

Instead, the gold standard for investigating deaths of mothers from pregnancy and childbirth is a statewide task force called a Maternal Mortality Review Committee, which reviews medical records and other documents related to every death of a mother, related to childbirth or pregnancy.

All of Alabama’s neighboring states have one already.

If the $478,000 is approved by the state legislature next year, it would fund Alabama’s new MMRC. Late last year, a coalition of Alabama doctors, nurses, public health leaders and other formed the state’s first MMRC under the umbrella of the Alabama Department of Public Health.

Right now, the MMRC operates on a shoestring budget, limiting the number of cases it can review. It’s mostly staffed with volunteers.

A group of Alabama OBYNs and the Medical Association worked with ADPH to come up with the $478,000 figure, said Trace Zarr, director of political development at the Medical Association.

The bulk of the money, about $300,000, would go toward hiring paid staff to compile and organize the case files of Alabama women who died from pregnancy or childbirth-related issues.

Another $108,000 would go toward autopsy reviews, and the rest would pay for support staff, equipment and supplies.

“We want to make sure we get not only a good count of the number of deaths, but qualitative data on the broader factors associated with these deaths,” said Britta Cedergren, director of maternal-child health and government affairs with the March of Dimes, which has partnered with the medical association and the state health department to lobby for funding.

“We want to determine whether these deaths were preventable. If it was a postpartum depression-related suicide, what could have been done differently? Or was there an undiagnosed issue related to pregnancy, like hypertension?”

If the MMRC is fully-funded, it could have a lasting impact on the health of mothers in the state.

Tennessee, which launched its MMRC program two years ago, found a whopping 85 percent of its maternal deaths were preventable.

California, one of the first to launch a review committee back in 2006, has since cut its rate of women dying in childbirth by 55 percent. That’s due in large part to is committee identifying two complications that were killing mothers but were largely preventable: hemorrhage and pregnancy-induced high blood pressure.

And Alabama already has a similar program that investigates infant deaths. Meigs credits the state-funded infant mortality review for reducing Alabama’s infant mortality rate in recent years. In 2017 Alabama’s infant mortality rate, still high by national standards, hit a state-record low.

“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,” he said, “we can’t expect to be able to make informed health policy decisions as a state, to move forward in eradicating maternal deaths.”

The Medical Association, a private professional organization that lobbies state lawmakers on behalf of doctors, has recently launched a new initiative, the Save Alabama Moms campaign. On its website, alabamamedicine.org/savealmoms, is the tagline: “It’s time to solve the maternal mortality crisis.”

Read more on motherhood in Alabama at al.com/motherhood. Join the conversation around issues that matter to women in the South on the Reckon Women group on Facebook. And for the best stories delivered straight to your inbox, sign up for our Reckon Women newsletter.

Click the image above to learn more about Alabama’s maternal mortality crisis.

Click the image to view the document outlining our request to fund the MMRC.

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