Maternal deaths – resulting from causes related to or aggravated by the pregnancy or its management up to one year after the end of pregnancy – are tragic events that have a profound negative impact on the children and families left behind, as well as their communities and the nation as a whole. In California, an estimated 80 women die each year from obstetric-related causes (maternal mortality rate 7.3 deaths per 100,000 live births in 2013). California is a microcosm of the U.S. – ethnically, geographically, economically, and with regard to health delivery. Approximately 1 in 8 U.S. births occurs in California annually (nearly 500,000 births at 260 delivery hospitals). Compared to the national rate, California’s maternal mortality rate is not only relatively low but also on the decline. However, improvements in maternal mortality rates have not benefitted all racial/ethnic groups equally. In particular, Black women are disproportionately affected, experiencing rates of maternal deaths 3 to 5 times higher than those of the other racial/ethnic groups (including White, Asian, and Hispanic women). Close to half of maternal deaths were determined to be preventable, but opportunities to intervene were missed, as California has learned through conducting in-depth maternal mortality case reviews.
California’s declining rate is the result of multifactorial public-private partnerships and collaborations, which informed translational activities, most notably, a series of provider and hospital toolkits to improve obstetric emergencies. The California Department of Public Health (CDPH) Maternal, Child and Adolescent Health (MCAH) Division established the California Pregnancy-Associated Mortality Review (CA-PAMR) in 2006 to investigate and inform strategies to improve the outcomes of pregnant and postpartum women, in collaboration with the California Maternal Quality Care Collaborative (CMQCC) and the Public Health Institute (PHI). To date, CA-PAMR has conducted over 1,000 case reviews of maternal deaths.
Despite these accomplishments, building capacity to provide and review current data on maternal deaths has been a challenge. CA-PAMR has scaled back its comprehensive case reviews, and, instead, is conducting less-detailed rapid-cycle reviews. With funding via this cooperative agreement, CA-PAMR will pilot a “maternal mortality reporting system” to make maternal mortality a reportable event for California, in addition to refining its existing infrastructure and framework, including the implementation of the Maternal Mortality Review Information Application (MMRIA) data system to facilitate data collection and reporting. CA-PAMR will also resume in-depth reviews to complement the ongoing rapid-cycle reviews. Lastly, CA-PAMR findings will inform possible development of further tools and quality improvement efforts to improve maternal and infant outcomes. Toolkits and best practices developed by California will continue to be shared nationally in the hopes of eliminating preventable maternal deaths in the U.S. CA-PAMR expects to (a) produce timely, accurate, and standardized information about California maternal deaths up to one year postpartum; (b) increase dissemination of the CA-PAMR project findings and data-driven recommendations; (c) implement data-driven recommendations to improve maternity care and support; (d) promote widespread implementation of quality improvement toolkits and policies to achieve the highest standards of care; and (e) reduce the incidence of maternal morbidity and mortality and narrow racial disparities.
