Promoting Equity in Maternal Mortality Review

As Asian American, Native Hawaiian, and Pacific Islander (AA and NHPI) Heritage Month comes to a close, the U.S. Department of Health and Human Services (HHS) Office of Minority Health (OMH) and the Centers for Disease Control and Prevention (CDC) commit to continuing to promote health equity for AA and NHPI communities. 

We’re focusing today on maternal health equity and highlighting the role OMH and the Centers for Disease Control and Prevention (CDC) play in promoting equity in maternal mortality review.

Understanding the Issue 

Despite spending more money per capita for perinatal care than any other nation in the world, the United States has higher rates of adverse pregnancy outcomes than any other high-income country. Women in the United States are more likely to die from childbirth than women living in other developed countries. 

According to 2017–2019 data in the Pregnancy Mortality Surveillance System, NHPI, American Indian and Alaska Native, and Black women are two to four times more likely to die from pregnancy-related complications than white women. The leading cause of pregnancy-related death also varies by race and ethnicity. Racial and ethnic minority women also face disparities related to severe maternal morbidity (SMM), or unexpected life-threatening complications of labor and delivery that may result in significant short- and long-term consequences to a woman's health.   

Between 2008 and 2021, Pacific Islander women saw the greatest increase in SMM, with a rise of 126%. Other populations also saw significant increases, including:  

• Asian women (79% increase)  
• American Indian women (57% increase)  
• Hispanic women (28% increase)  
• White women (20% increase)  
• Black women (10% increase)  

Addressing these disparities by eliminating barriers to quality care and fostering equity is a key step to improving maternal health outcomes for all women.  

Supporting Solutions

To address these pregnancy-related disparities, OMH and CDC partnered to develop resources focused on promoting equity in maternal mortality review and prevention. This means supporting the work of:   

• Maternal Mortality Review Committees (MMRCs), which convene at state and local levels to review deaths that occur during or within one year of pregnancy, and   
• Perinatal Quality Collaboratives (PQCs), which identify health care processes that need to be improved to enhance quality of care for mothers and babies.    

The three efforts highlighted below support MMRCs and PQCs in their critical work to better understand and address the drivers of maternal mortality and other complications of pregnancy.  

Strengthening Connections between Communities and MMRCs and PQCs

Working with CDC, MMRCs provide recommendations for preventing pregnancy-related deaths and PQCs implement actions to improve quality of care. Community-based organizations (CBOs) can provide valuable input to help address social determinants of health that impact maternal mortality and morbidity, but they often face challenges engaging with MMRCs and PQCs.   

CDC, alongside OMH and partners, is identifying ways to improve collaboration between MMRCs, PQCs, and CBOs to address inequities in maternal mortality and morbidity. Strategies identified through this effort will support more effective collaboration among MMRCs, PQCs, and CBOs to better prioritize equity and improve maternal health outcomes for racial and ethnic minority populations.    

Developing a Discrimination and Racism Detection Tool

To better support MMRCs in their ability to identify instances of discrimination and racism from medical records, OMH and CDC partnered with the American College of Obstetricians and Gynecologists to develop a discrimination and racism detection tool. When released, the tool will be used by MMRCs as they review records on pregnancy-related deaths to ensure better consistency and accuracy in identifying these contributors to maternal health disparities.  

Integrating Community Vital Signs Dashboards

OMH and CDC provided resources for adding "Community Vital Signs" dashboards and data into CDC’s Maternal Mortality Review Information App, a data system and web portal specifically for MMRCs. The Community Vital Signs data include:  

• poverty rate,   
• obstetricians or nurse midwives per capita,   
• community levels of education,   
• unmet need for drug treatment, and   
• violent crime rates  

Integrating these data helps MMRCs to identify community- or system-level contributors to pregnancy-related mortality during review. Understanding these contributors can play a pivotal role in formulating recommendations for improving maternal health outcomes that take into account community- and system-level factors.  

Through these concerted efforts, OMH and CDC are proactively working to mitigate disparities in maternal health outcomes and develop actionable opportunities for preventing pregnancy-related mortality.  We encourage MMRCs, PQCs, and CBOs to use these resources to support maternal health equity efforts in your states and territories.   

We’d like to close by thanking the CDC Maternal Mortality Prevention Team for their unwavering dedication and leadership in safeguarding the lives of mothers and babies.  

Related Resources

• Think Cultural Health’s Culturally and Linguistically Appropriate Services (CLAS) in Maternal Health Care e-learning course  
• Hear Her: A CDC campaign sharing messaging about urgent warning signs to prevent pregnancy-related deaths. 
• Hear Her Campaign Resources for American Indian and Alaska Native People   
• Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE MM)