Maternal Mortality Review Committees (MMRCs) operate at the state and local levels and play a vital role in understanding and addressing maternal mortality by systematically reviewing maternal deaths to identify preventable factors. The recent Dobbs v. Jackson Women’s Health Organization decision has raised concerns about access to reproductive healthcare, which may exacerbate maternal health outcomes.
Objective:
In a series of recent political moves, the state of Idaho passed legislation to both restrict abortion care and replace its state-level MMRC with what will likely be a pro forma board. This article is a response to these legislative decisions, which have not been isolated and must be understood in the context of the Dobbs decision.
Methods:
The analysis draws on existing literature regarding maternal mortality data and its limitations, as well as MMRCs, their functions, and their impact on maternal health.
Results:
MMRCs serve a pertinent public health function. As such, maintaining these committees is critical to maternal surveillance systems, racial and ethnic equity, and reproductive and criminal justice. Furthermore, although MMRCs are beneficial for understanding the drivers of maternal mortality and complications of pregnancy, as well as determining applicable patient, provider, and community interventions, they are also subject to political interference and affected by restrictive reproductive laws.
Conclusion:
In the wake of the Dobbs decision, it is imperative to uphold and strengthen MMRCs as they are integral to advancing maternal health initiatives. This work ultimately provides an informative narrative and a call to action, as women’s health is at stake.
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References
1.
HoyertDL. Maternal mortality rates in the United States, 2021 [Internet]. NCHS Health E-Stats. 2023 [cited 2024 Apr 5]. Available from: https://stacks.cdc.gov/view/cdc/124678
2.
ElyDM, DriscollAK. Infant mortality in the United States, 2021: Data from the period linked birth/infant death file. Natl Vital Stat Rep, 2023; 72(11):1–19.
3.
SivaN. Maternity care crisis worsening across the USA. Lancet, 2023; 402(10416):1956–1957.
4.
StevensonAJ, RootL, MenkenJ. The maternal mortality consequences of losing abortion access [Internet]. SocArXiv, 2022 [cited on 2024 Apr 5]. Available from: osf.io/preprints/socarxiv/7g29k
5.
SinghS, RemezL, SedghG, et al.Abortion worldwide 2017: uneven progress and unequal access. New York: Guttmacher Institute; 2018.
6.
KheyfetsA, DhauraliS, FeyockP, et al.The impact of hostile abortion legislation on the United States maternal mortality crisis: A call for increased abortion education. Front Public Health, 2023; 11:1291668.
7.
AhrensKA, HutcheonJA. Time for better access to high-quality abortion data in the United States. Am J Epidemiol, 2020; 189(7):640–647.
Centers for Disease Control and Prevention. State strategies for preventing pregnancy-related deaths: a guide for moving maternal mortality review committee data to action. Atlanta, GA: National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention; 2022.
10.
CreangaAA. Maternal mortality in the United States: A review of contemporary data and their limitations. Clin Obstet Gynecol, 2018; 61(2):296–306.
Moyle v. United States. (2024). U.S. Supreme Court.
15.
TrostSL, BeauregardJ, PetersenEE, et al.Identifying deaths during and after pregnancy: New approaches to a perennial challenge. Public Health Rep, 2023; 138(4):567–572.
16.
International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) [Internet]. 2019 [cited 2024 Apr 5]. Available from: https://icd.who.int/browse10/2019/en
JosephKS, LisonkovaS, MuracaGM, et al.Factors underlying the temporal increase in maternal mortality in the United States. Obstet Gynecol, 2017; 129(1):91–100.
19.
HoyertDL. Maternal mortality and related concepts. Vital Health Stat 3, 2007(33):1–13.
20.
HoyertDL, MiniñoAM. Maternal mortality in the United States: Changes in coding, publication, and data release, 2018. Natl Vital Stat Rep, 2020; 69(2):1–18.
21.
DavisGG, OnakaAT. Report on the 2003 revision of the U.S. standard certificate of death. Am J Forensic Med Pathol, 2001; 22(1):38–42.
22.
CatalanoA, DavisNL, PetersenEE, et al.Pregnant? Validity of the pregnancy checkbox on death certificates in four states, and characteristics associated with pregnancy checkbox errors. Am J Obstet Gynecol, 2020; 222(3):269.e1––269.e8.
23.
NelsonDB, MonizMH, DavisMM. Population-level factors associated with maternal mortality in the United States, 1997–2012. BMC Public Health, 2018; 18(1):1007.
24.
CollierAY, MolinaRL. Maternal mortality in the United States: Updates on trends, causes, and solutions. Neoreviews, 2019; 20(10):e561–e574.
25.
MacDormanMF, DeclercqE, CabralH, et al.Recent increases in the U.S. Maternal mortality rate: Disentangling trends from measurement issues. Obstet Gynecol, 2016; 128(3):447–455.
26.
BerdzuliN, LomiaN, StaffAC, et al.Maternal mortality in Georgia: Incidence, causes and level of underreporting: A national reproductive age mortality study 2014. Int J Womens Health, 2020; 12:277–286.
27.
DiguistoC, SaucedoM, KallianidisA, et al.Maternal mortality in eight European countries with enhanced surveillance systems: Descriptive population-based study. BMJ, 2022; 379:e070621.
28.
BaevaS, SaxtonDL, RuggieroK, et al.Identifying maternal deaths in Texas using an enhanced method, 2012. Obstet Gynecol, 2018; 131(5):762–769.
29.
DavisNL, HoyertDL, GoodmanDA, et al.Contribution of maternal age and pregnancy checkbox on maternal mortality ratios in the United States, 1978-2012. Am J Obstet Gynecol, 2017; 217(3):352.e1–352.e7.
30.
RossenLM, WomackLS, HoyertDL, et al.The impact of the pregnancy checkbox and misclassification on maternal mortality trends in the United States, 1999-2017. Vital Health Stat 3, 2020(44):1–61.
31.
CreangaAA, ThomaM, MacDormanM. Value and disvalue of the pregnancy checkbox on death certificates in the United States–impact on newly released 2018 maternal mortality data. Am J Obstet Gynecol, 2020; 223(3):393.e1–393.e4.
32.
JosephKS, LisonkovaS, BoutinA, et al.Maternal mortality in the United States: Are the high and rising rates due to changes in obstetrical factors, maternal medical conditions, or maternal mortality surveillance? Am J Obstet Gynecol, 2024; 230(4):440.e1–440.e13.
33.
HuangRS, SpenceAR, AbenhaimHA. Non-obstetric maternal mortality trends by race in the United States. Matern Child Health J, 2024; 28(5):895–904; doi: 10.1007/s10995-023-03862-7
34.
ChengD, HoronIL. Intimate-partner homicide among pregnant and postpartum women. Obstet Gynecol, 2010; 115(6):1181–1186.
35.
FildesJ, ReedL, JonesN, et al.Trauma: The leading cause of maternal death. J Trauma, 1992; 32(5):643–645.
36.
DietzPM, RochatRW, ThompsonBL, et al.Differences in the risk of homicide and other fatal injuries between postpartum women and other women of childbearing age: Implications for prevention. Am J Public Health, 1998; 88(4):641–643.
37.
WallaceME, HoyertD, WilliamsC, et al.Pregnancy-associated homicide and suicide in 37 US states with enhanced pregnancy surveillance. Am J Obstet Gynecol, 2016; 215(3):364.e1–364.e10.
38.
CampbellJ, Matoff-SteppS, VelezML, et al.Pregnancy-associated deaths from homicide, suicide, and drug overdose: Review of research and the intersection with intimate partner violence. J Womens Health (Larchmt), 2021; 30(2):236–244.
MehtaPK, BachhuberMA, HoffmanR, et al.Deaths from unintentional injury, homicide, and suicide during or within 1 year of pregnancy in Philadelphia. Am J Public Health, 2016; 106(12):2208–2210.
41.
MetzTD, RovnerP, HoffmanMC, et al.Maternal deaths from suicide and overdose in Colorado, 2004-2012. Obstet Gynecol, 2016; 128(6):1233–1240.
42.
PetersenEE, DavisNL, GoodmanD, et al.Vital signs: Pregnancy-related deaths, United States, 2011–2015, and strategies for prevention, 13 states, 2013–2017. MMWR Morb Mortal Wkly Rep, 2019; 68(18):423–429.
43.
TrostS, BeauregardJ, ChandraG, et al.Pregnancy-related deaths: Data from maternal mortality review committees in 36 US states, 2017–2019. Educ, 2022; 45(10):1–0.
44.
NagleA, SamariG. State-level structural sexism and cesarean sections in the United States. Soc Sci Med, 2021; 289:114406.
45.
KozhimannilKB, LawMR, VirnigBA. Cesarean delivery rates vary tenfold among US hospitals; reducing variation may address quality and cost issues. Health Aff (Millwood), 2013; 32(3):527–535.
46.
LeonardSA, MainEK, CarmichaelSL. The contribution of maternal characteristics and cesarean delivery to an increasing trend of severe maternal morbidity. BMC Pregnancy Childbirth, 2019; 19(1):16–19.
47.
FinkDA, KildayD, CaoZ, et al.Trends in maternal mortality and severe maternal morbidity during delivery-related hospitalizations in the United States, 2008 to 2021. JAMA Netw Open, 2023; 6(6):e2317641.
48.
CarrollAE. Why is US maternal mortality rising? JAMA, 2017; 318(4):321.
49.
SimpsonKR. Effect of the covid-19 pandemic on maternal health in the United States. MCN Am J Matern Child Nurs, 2023; 48(2):61.
50.
GoodmanD, StampfelC, CreangaAA, et al.Revival of a core public health function: State- and urban-based maternal death review processes. J Womens Health (Larchmt), 2013; 22(5):395–398.
KramerMR, StrahanAE, PreslarJ, et al.Changing the conversation: Applying a health equity framework to maternal mortality reviews. Am J Obstet Gynecol, 2019; 221(6):609.e1–609.e9.
53.
LindsayMK, GoodmanD, CsukasS, et al.; Georgia Maternal Mortality Review Committee. Partnering of public, academic, and private entities to reestablish maternal mortality review in Georgia. Obstet Gynecol, 2017; 130(3):636–640.
BrightM, AmendolaA, Roussos-RossD. Maternal Mortality Review Committees should take a closer look at homicide deaths. Am J Obstet Gynecol, 2024; 231(2):143–146.
TestaA, JacksonDB, VaughnMG, et al.Incarceration as a unique social stressor during pregnancy: Implications for maternal and newborn health. Soc Sci Med, 2020; 246:112777.
58.
HailuEM, RiddellCA, BradshawPT, et al.Structural racism, mass incarceration, and racial and ethnic disparities in severe maternal morbidity. JAMA Netw Open, 2024; 7(1):e2353626.
59.
JeffersNK, BergerBO, MareaCX, et al.Investigating the impact of structural racism on Black birthing people-associations between racialized economic segregation, incarceration inequality, and severe maternal morbidity. Soc Sci Med, 2023; 317:115622.
ShlaferRJ, GerrityE, NorrisC, et al.Justice for incarcerated moms act of 2021: Reflections and recommendations. Womens Health (Lond), 2022; 18:17455057221093037.
62.
CarsonEA. Prisoners in 2020–Statistical tables [Internet]. Bureau of Justice Statistics. 2021; 302776:1–50. [cited on 2024 Apr 5]. Available from: https://bjs.ojp.gov/content/pub/pdf/p20st.pdf
63.
IrazolaS, MaruschakLM, BronsonJ. Data on maternal health and pregnancy outcomes from prisons and jails: Results from a feasibility study [Internet]. Bureau of Justice Statistics. [cited on 2024 Apr 5] 14p. Available from: https://bjs.ojp.gov/document/dmhpopj.pdf
64.
KaufmanR, BrownR, Martinez CoralC, et al.Global impacts of Dobbs v. Jackson Women’s Health Organization and abortion regression in the United States. Sex Reprod Health Matters, 2022; 30(1):2135574.
HarperLM, LeachJM, RobbinsL, et al.All-cause mortality in reproductive-aged females by state: An analysis of the effects of abortion legislation. Obstet Gynecol, 2023; 141(2):236–242.
76.
AddanteAN, EisenbergDL, ValentineMC, et al.The association between state-level abortion restrictions and maternal mortality in the United States, 1995-2017. Contraception, 2021; 104(5):496–501.
77.
TrederKM, Amutah-OnukaghaN, WhiteKO. Abortion bans will exacerbate already severe racial inequities in maternal mortality. Womens Health Issues, 2023; 33(4):328–332.
78.
VolkinS, MayerRE, DingwallA. Documenting maternal deaths: Implications for national statistics and research. Womens Health Issues, 2021; 31(3):201–203.
