Missouri experiences several challenges relating to factors that are likely to significantly impact maternal morbidity and mortality trends. From 2014-2016, the Missouri three-year moving average of maternal mortality rates (33.4 maternal deaths per 100,000 live births) was higher than the national three-year moving average of 21.4 and about three times the Healthy People 2020 target of 11.4 deaths per 100,000 live births. Missouri ranks 42nd among U.S. states for maternal mortality. Between 2010 and 2017, the maternal mortality rate among black mothers (66.7 per 100,000 live births) was nearly 2.5 times higher than that of white women (27.0 per 100,000 live births).
This funding will support Missouri’s Pregnancy-Associated Mortality Review (PAMR) Program by facilitating timely identification of maternal deaths, formation and dissemination of prevention strategies, and implementation of strategies to reduce maternal deaths and associated racial disparities. The Missouri Department of Health and Senior Services (MODHSS) Division of Community and Public Health/Section for Women’s Health staff will oversee the grant project. The PAMR Program has convened a maternal mortality review committee since 2011 and has hosted 20 meetings since that time.
With funding support and technical assistance provided by the Centers for Disease Control and Prevention, Missouri’s PAMR Program will decrease the time it takes to identify maternal mortality cases, increase the formation of prevention strategies and dissemination of findings, and increase the implementation of prevention activities. Missouri’s goal is to see a ten percent decline in overall statewide severe maternal morbidity (SMM) and a fifteen percent decline in SMM from preeclampsia by 2024. Missouri estimates that the number of people to be served as a result of this grant will be 73,000 pregnant women.
To implement these activities, PAMR will collaborate with internal and external stakeholders. Within MODHSS, the Office of Epidemiology and Bureau of Vital Statistics will provide data access and dedicated analytical support to identify cases and monitor operations and progress towards outcomes. External partners, including the Missouri Chapter of the American College of Obstetricians and Gynecologists and the Missouri Hospital Association will assist with the dissemination of reports and recommendations, and advise on implementation of best practices and policy. Partnerships will be strengthened with organizations including FLOURISH St. Louis to integrate PAMR recommendations into population-based public health initiatives to address social determinants of health and health inequities.