Memorandum of Support: Maternal Mortality Review Board
The American College of Obstetricians and Gynecologists (ACOG), District II strongly supports this legislation to establish a maternal mortality review board in New York State. As ob-gyns, ACOG’s members have a professional obligation and moral imperative as clinicians to find out why maternal deaths and the stark racial disparities occur, and to develop actionable strategies for prevention. With New York lagging behind much of the nation in terms of its maternal death ranking, it is imperative that legislators act now to create an enhanced review process to reduce maternal deaths and complications.
Through this legislation, New York would establish a maternal mortality review board – a diverse group of multidisciplinary experts that will conduct an enhanced review process to assess the causes of maternal death, factors leading to death, preventability, and opportunities for intervention. The bill also would require the board to report on its aggregate findings and recommendations in order to share best practices on the prevention of maternal death and complications. This
information would be shared with providers, communities, and the public to ensure broad reach and community engagement.
This legislation is a reflection of national best practices on maternal mortality reviews that have been established across the nation. This legislation:
- Ensures accountability and sustainability of a maternal mortality review board;
- Ensures the board is diverse, multi-disciplinary and includes experts who serve and are representative of the
diversity of women and mothers in medically underserved areas of the state;
- Provides confidentiality protections to the board’s proceedings to allow for open and honest dialogue and review;
- Ensures the board reports on aggregate findings and recommendations.
ACOG, in partnership with a broad range of health care providers, patient advocacy organizations, reproductive health organizations and legislators calls for the swift passage of this legislation. This bill ensures the board has sufficient confidentiality protections which is critical to conducting meaningful quality improvement work and ultimately achieving a reduction in preventable maternal deaths and the stark racial disparities that exist in maternal mortality and morbidity across this state. Confidentiality is the cornerstone of similar maternal mortality reviews that have been established across the country. New York legislation should align with national best practices as established by the CDC Foundation.1 This legislation creates a safe space for experts to analyze cases of maternal death in order to fully understand the causes and factors leading to maternal deaths in the state, and implement new strategies for prevention.
Despite having some of the most progressive policies on women’s health access and being home to some of the most clinically advanced, state of the art medical facilities globally, New York currently ranks 30th out of 50 states in its maternal death rate.2 Since 2013, ACOG’s Safe Motherhood Initiative (SMI) has worked with 117 hospitals across New York State to prevent maternal mortality through development and implementation of evidence-based practice on the three leading causes of maternal death. Hospitals report that the SMI directly impacted their ability to improve patient care and provided them the tools to do so. While improvements have been made, our state’s maternal mortality ranking suggests the need for a broader statewide effort to review maternal deaths and develop strategies for prevention.
This public health crisis is compounded by significant racial disparities and the interplay with social determinants of health. Black women are nearly four times more likely to die during pregnancy and childbirth compared to white women.3 Sixty -seven percent of maternal deaths from 2012-2013 were among women insured through the Medicaid program.4 Severe maternal morbidity rates – life threatening complications of delivery- are highest among women living in high poverty neighborhoods and women with an underlying chronic condition such as high blood pressure, diabetes, or heart disease have a threefold likelihood of having severe maternal morbidity as women with no chronic conditions.5 Similarly, severe maternal morbidity has increased steadily in recent years—in New York City the rate rose 28.2% from 2008 to 2012.6 Maternal mortality in New York is a public health crisis, and it is critical that the legislature act this session to enable this meaningful work to move forward. This legislation must be enacted to ensure that the review board is able to function at its full capacity, and for these reasons ACOG District II urges lawmakers to support this bill.
1 CDC Foundation; AMCHP Review to Action; Working Together to Prevent Maternal Mortality: http://www.reviewtoaction.org/
2 America’s Health Rankings. Explore Maternal Mortality in New York | 2016 Health of Women and Children Report, 2017. http://www.americashealthrankings.org/explore/2016-health-of-women-and-childrenreport/measure/maternal_mortality/state/NY, Accessed August 31, 2017
3 Centers for Disease Control and Prevention. Pregnancy Mortality Surveillance System. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pmss.html, Accessed August 31, 2017
4 New York State Department of Health. New York State Maternal Mortality Review: Update. July 25, 2017.
6 New York City Department of Health & Mental Hygiene. Severe Maternal Morbidity Report, 2008-2012. https://www1.nyc.gov/assets/doh/downloads/pdf/data/maternal-morbidity-report-08-12.pdf, Accessed September 13, 2017.