Enhancing Reviews and Surveillance to Eliminate Maternal Mortality - The Guam Department of Public Health and Social services (DPHSS) proposes to implement several strategies to address high maternal mortality: (1) improve the quality and availability of death records on Guam through a consistent process to enable thorough maternal death review, (2) implement a standardized process for selecting maternal deaths for review, and for obtaining additional information from medical and other records, and interviews, (3) establish a Maternal Mortality Review Committee to conduct population level review of possible pregnancy-related deaths and relevant data, and to make recommendations for the prevention of maternal deaths, and (4) analyze existing Vital Statistics data and MMRIA data and disseminate findings to committee members, the health professionals on the island, the general population, and populations of special focus who are at higher risk of maternal death. There are five main outcomes for this proposed project, three short-term and two intermediate term. Short term outcomes: (1) increased timeliness, accuracy, and standardization of information available about pregnancy-related deaths, including MMRC identified opportunities for prevention; (2) increased engagement and cooperation between MMRCs, partners, and communities to communicate information from data on pregnancy-related deaths; and (3) Increased availability of MMRC recommendations among communities, clinicians, public health practitioners, and decision-makers. These should lead to the intermediate outcomes of (1) Increased adoption of clinical and non-clinical policies and programs that reflect the highest standards of care, and (2) Increased implementation of recommendations that reach or consider the needs of populations disproportionately affected by pregnancy-related mortality.