In-Depth: Rep. Jaime Herrera Beutler (R-WA) introduced this bill to help save women’s lives and improve the quality of healthcare and health outcomes for moms and babies by helping states establish or support Maternal Mortality Review Committees (MMRCs) to examine pregnancy-related and pregnancy-associated deaths and identify ways to reduce them:
“Unlike in any other industrialized nation, the U.S. is seeing a rise in pregnancy-related deaths. For the sake of so many mothers and babies, we have to do better. Helping to establish and support Maternity Mortality Review Committees in states is a direct way to reverse this trend. I hope that through this legislative effort, we can help save the lives of women and children during pregnancy, childbirth, and in the postpartum period.”
Rep. Herrera Beutler adds that the U.S. has a higher maternal death rate than some developing countries, and argues that the multifaceted nature of maternal death requires careful study:
“The U.S. right now is worse than Iran. Their maternal death rate is lower than ours per hundred thousand births. For African-American women in New Jersey, the death rate was around 79 per hundred thousand births. On average nationwide, it’s around 40. For white women, it’s around 14 per hundred thousand… In every state, we would investigate every maternal death. It’s shocking to think in 21st century America, we don’t have the answers to this… What I’ve found is it’s racial, it’s regional, it’s class, it’s gender — there are disparities throughout health care and depending on where you’re at, we find the answer, which is why we have to investigate each and every maternal death.”
In a joint op-ed in The Hill, Reps. Herrera Beutler and Raja Krishnamoorthi (D-IL) argue that it’s time for an ambitious plan to address maternal mortality:
“The time has come for an ambitious plan to stem the rising tide of tragic death and illness our nation is facing. Eliminating all preventable maternal deaths is a lofty goal to be sure, but that is precisely why our nation should pursue it. We cannot be satisfied until we have the lowest maternal mortality rate in the world and we can prevent any woman from dying in childbirth due to preventable conditions for lack of proper care.”
Dr. Thomas M. Gellhaus, President of the American Congress of Obstetricians and Gynecologists (ACOG), supports MMRCs as a key to reducing maternal mortality:
“Our nation’s ob-gyns are extremely concerned by the alarming rates of maternal death in the United States, especially among communities of color, but we know MMRCs are a key component to reversing this trend. This legislation will allow us to understand what is driving these tragic incidents by providing the needed funding to create review committees that will collect standardized data in order to inform effective and cost-saving solutions that fit each community.”
The American Academy of Family Physicians supports this bill as a life-saving initiative that’d help gather more information about maternal mortality:
“We are pleased to support a bill that addresses a vital public health issue because family physicians play an important role in providing pre- and postnatal care for women. Research indicates that preeclampsia and hypertension are leading causes of maternal mortality and contribute to infant mortality. Despite advances in medicine and public health, America has the highest maternal mortality rate in the developed world. Maternal deaths are more likely to occur among African-American, rural, and low-income women. We know that many of these deaths are preventable, but more can be done to understand why the nation’s maternal mortality rates spiked in every state and increased nationally by 26.6 percent from 2000 to 2014. [This bill] would establish or support state maternal mortality review committees to examine the causes of pregnancy-related deaths and identify the best strategies for improving pregnancy health outcomes. The data collected from these activities will be shared with the U.S. Centers for Disease Control and Prevention.”
A USA TODAY investigation called state investigations of maternal health outcomes into question, finding that:
“Turns out, well-meaning states across the country have been doing it wrong. At least 30 states have avoided scrutinizing medical care provided to mothers who died, or they haven't been studying deaths at all.. Instead, many state committees emphasized lifestyle choices and societal ills in their reports on maternal deaths. They weighed in on women smoking too much or getting too fat or on their failure to seek prenatal medical care. Virginia published entire reports about cancer, opioid abuse and motor vehicle crashes among moms who died. Minnesota’s team recommended more education for pregnant women on seat belt use and guns in the home. Michigan’s team urged landlords to make sure pregnant women’s homes have smoke detectors… women’s lives could be saved if doctors and nurses took simple steps, including measuring blood loss during and after delivery and giving timely treatment for high blood pressure. Yet state panels across the country have focused a fraction of their attention on the quality of care hospitals provide or on advocating for improvements.”
This bill has been referred to the House Subcommittee on Health with the support of 185 cosponsors, including 137 Democrats and 48 Republicans.
It also has the support of ACOG, the Preeclampsia Foundation, Every Mother Counts, the Amniotic Fluid Embolism Foundation, the American Academy of Family Physicians, March of Dimes, and others. The ACOG and Preeclampsia Foundation are this bill’s supporting organizations.
There’s a companion version of this bill in the Senate co-sponsored by Sens. Heidi Heitkamp (D-ND) and Shelley Moore Capito (R-WV). That bill passed the Senate Committee on Health, Education, Labor and Pensions (HELP) with a funding level increase from $7 million to $12 million each year for five years. The Senate bill has 42 cosponsors, including 36 Democrats, five Republicans, and one Independent.
Of Note: The U.S. is ranked 47th globally for maternal mortality. Additionally, it stands out among industrialized nations as the only one in which maternal deaths are on the rise. In 2014, the maternal mortality rate (measured in maternal deaths per 100,000 live births) increased from 18.8 in 2000 to 23.8 that year (excluding California and Texas). While maternal mortality is significantly more common among African-Americans, low-income women and rural residents, pregnancy and childbirth complications kill women of every race and ethnicity, education and income level, in every part of the U.S.
Yet, it doesn’t have to be this way. According to the CDC, 60% of maternal deaths are preventable — and women in other countries are much less likely than American women to die due to motherhood. In a joint investigation, NPR and ProPublica found:
“American women are more than three times as likely as Canadian women to die in the maternal period (defined by the Centers for Disease Control as the start of pregnancy to one year after delivery or termination), six times as likely to die as Scandinavians. In every other wealthy country, and many less affluent ones, maternal mortality rates have been falling; in Great Britain, the journal Lancet recently noted, the rate has declined so dramatically that ‘a man is more likely to die while his partner is pregnant than she is.’ But in the U.S., maternal deaths increased from 2000 to 2014.”
The NPR/ProPublica investigation points out that unlike the U.K., the U.S. has no centralized government effort to investigate maternal deaths:
“[In the U.K.] maternal deaths are regarded as systems failures. A national committee of experts scrutinizes every death of a woman from pregnancy or childbirth complications, collecting medical records and assessments from caregivers, conducting rigorous analyses of the data, and publishing reports that help set policy for hospitals throughout the country. Coroners also sometimes hold public inquests, forcing hospitals and their staffs to answer for their mistakes. The U.K. process is largely responsible for the stunning reduction in preeclampsia deaths in Britain… [Meanwhile], the U.S. has no comparable federal effort. Instead, maternal mortality reviews are left up to states. As of [spring 2017], 26 states (and one city, Philadelphia) had a well-established process in place; another five states had committees that were less than a year old. In almost every case, resources are tight, the reviews take years, and the findings get little attention.”
This bill is the product of a several years-long process in which dozens of stakeholders contributed ideas and legislative language to the bill text. Ultimately, this process identified providing greater federal support for MMRCs as a key policy solution, and a group of interested members of Congress wrote a bill to help states expand their efforts. A coalition of national organizations, including the Association of Maternal & Child Health Programs, ACOG, the Association of Women's Health, Obstetric & Neonatal Nurses (AWHONN), March of Dimes, Preeclampsia Foundation, and the Society for Maternal-Fetal Medicine (SMFM), provided technical assistance and rallied behind the bill's introduction.
Summary by Lorelei Yang(Photo Credit: iStockphoto.com / KatarzynaBialasiewicz)