Policy Analysis of the 2020–2021 Report on Maternal Mortality in Massachusetts Using the Conceptual Model of Nursing and Health Policy

Abstract

Despite being a high-resource nation, the U.S. maternal mortality rate has been steadily rising since 1997 and disproportionately affects disenfranchised groups and communities. In 2024, the Massachusetts Maternal Mortality and Morbidity Review Committee released recommendations for remedial policy and practice changes based on a thorough review of 25 pregnancy-related in-state deaths, the majority of which were deemed preventable. The purpose of this paper is to use the conceptual model of nursing and health policy to analyze the committee's recommendations to determine their capacity to contribute to a comprehensive strategy against maternal mortality as well as their connection to perinatal nursing practices. The method involved classifying the report recommendations based on their strongest connection to specific levels of the conceptual model to highlight opportunities for nurses to engage with the policy recommendations. Results demonstrated that each of the recommendations aligned with one of the model's four levels (individual, community, geopolitical unit, global), demonstrating comprehensiveness and a focus on efficacy, quality, effectiveness, cost-effectiveness, accessibility, and social justice. Future action plans should consider the following recommendations absent from the report: (1) implementation of standardized obstetric protocols, (2) extension of duration/scope of postpartum care, (3) increasing access to screening and treatment for perinatal mental health conditions, midwifery care, community birth options, and telehealth, and (4) performing qualitative research to gain further insights from groups most affected by maternal mortality. This analysis shows that the report's recommendations are largely implementable through nursing practice and can serve as a model for all states.