Background: Massachusetts (MA) is consistently one of the healthiest states in the nation. However, racial inequities in maternal health outcomes exist. Since 1998, rates of pregnancy-associated mortality and severe maternal morbidity have steadily risen in MA. Black birthing people are almost twice as likely to die during pregnancy or within one year postpartum as White birthing people. The MA Department of Public Health (MDPH) proposes to improve the capacity of the MA Maternal Mortality and Morbidity Review Committee (M4RC) to characterize pregnancy-associated deaths and implement data-informed and community-engaged strategies to prevent maternal deaths and reduce inequities in maternal health outcomes.
Purpose: MDPH proposes to expand, enhance, and expedite our current M4RC process to identify all pregnancy-associated deaths; collect and analyze timely and relevant data; conduct a comprehensive review of each death to better understand contributing factors; engage community members in committee reviews, data interpretation, and development of prevention recommendations; and disseminate findings through provider and community partners.
Outcomes: The M4RC seeks to eliminate preventable deaths that occur during pregnancy and the year after pregnancy and inequities in maternal deaths. The project’s desired outcomes include: 1) increased timeliness, accuracy, and standardization of information available about pregnancy-related deaths, including documented opportunities for prevention, 2) increased availability of recommendations of the M4RC among communities, clinicians and policy makers, and 3) increased networking and cooperation between the M4RC and communities to communicate information from data on pregnancy-related deaths.
Strategies and Activities: MDPH will carry out all required strategies and activities that align with these outcomes. The M4RC will identify pregnancy-associated deaths within 12 months of death and fully abstract clinical and non-clinical data on all pregnancy-associated deaths and enter them into MMRIA within 18 months of death. CDC-generated Quality Assurance Reports will launch internal reviews that together improve data quality, completeness, and timeliness. The review process will result in the development of prevention strategies to reduce the incidence of maternal deaths and associated racial and ethnic inequities. These recommendations will be broadly disseminated to communities, clinicians, and policy makers.
Evaluation & Performance Measurement Plan: The evaluation will assess whether proposed activities are being implemented as intended and the extent to which those activities are achieving the desired outcomes. We will collect data on process and outcome measures, and evaluation findings will frequently be shared with key partners and used throughout the project to identify barriers to progress and opportunities to improve performance and sustain improvements over time.
Capacity: MDPH is well-positioned to support the expansion of the M4RC. The M4RC has statutory authority to implement the proposed activities and support from MDPH leadership and key clinical and community partners. MDPH and M4RC have capacity to access data, ensure confidentiality, staff and manage the project, and use the CDC developed MMRIA database. With a robust accounting, purchase of services, and multiple checks and balances in place, BFHN has extensive and successful experience managing federal grants.
