New York State Department of Health Releases New Report On Maternal Mortality

First Report by the State Department of Health's Maternal Mortality Review Board (MMRB) and Maternal Mortality & Morbidity Advisory Council (MMMAC)

New Data Provides Insight, Analysis, and Recommendations to Address Systemic Inequalities and Create Safer Birth Experiences for New York Families

To Further Improve Maternal Health Outcomes and Reduce Racial Disparities, Governor Hochul's 2023 Enacted Budget Includes Over $20 Million in Annual Investments to Expand Access to Pre and Postnatal Care and Postpartum Coverage From 60 Days to One Year

Read the Full Report Here

ALBANY, N.Y. (April 13, 2022) - The New York State Department of Health today announced the release of a new report on maternal mortality, "The New York State Report of Pregnancy-Associated Deaths in 2018", part of the State's ongoing commitment to address systemic inequities and create safer birth experiences for mothers and families. The new report represents the culmination of the work of the New York State Maternal Mortality Review Board (MMRB) and the New York State Maternal Mortality & Morbidity Advisory Council (MMMAC) to identify common factors contributing to death and develop the recommendations needed to improve the health and safety of pregnant New Yorkers statewide.

"Examining maternal health outcomes from a racial equity perspective is critical to unearthing institutional issues so they can be addressed," New York State Health Commissioner Dr. Mary T. Bassett said. "I applaud the collaborative work by the Department's Maternal Mortality Review Board and the Maternal Mortality & Morbidity Advisory Council, which took a hard and honest look at the root causes of these issues – providing the Department with an actionable blueprint to better future outcomes. Access to good, quality maternal healthcare should be guaranteed to every pregnant New Yorker, and the Department remains committed to the findings from this work."

In addition to the published findings, and to successfully improve maternal health outcomes and reduce racial disparities, Governor Hochul's FY 2023 Enacted Budget includes over $20 million in annual investments designed to expand access to holistic prenatal and postnatal care to make quality care accessible for all mothers. The state will also expand postpartum coverage for all individuals eligible for Medicaid while pregnant from 60 days to one year after they give birth. A key element of the report's recommendations, this will lead to more equitable outcomes for New York families.

The New York State Maternal Mortality Review Board (MMRB) is comprised of a diverse, multidisciplinary group of experts in maternal health-related fields charged with reviewing maternal deaths. Through this process, members identify the circumstances leading to death, common causes of death, and develop recommendations to the State's Health Commissioner to prevent similar deaths in the future. The Maternal Mortality Review Board (MMRB) works in concert with the State's Maternal Mortality & Morbidity Advisory Council (MMMAC)to further refine and expand on recommendations. Advisory Council members include community members, home visitors, health care providers, doulas, and advocates who work collectively to uplift community voice in the shared recommendations. Representing the culmination of this work, the report is the first of its kind for New York, issued jointly from the State's Maternal Mortality Review Board (MMRB) and the Maternal Mortality & Morbidity Advisory Council (MMMAC). Other contributors include the New York City Maternal Mortality and Morbidity Review Committee (M3RC), providing a comprehensive statewide view of the issue including from New York City.

Key findings from the report include the following:

  • There were 41 pregnancy-related deaths in 2018: Of all women in New York State who died within one year of being pregnant in 2018, 41 of them were found to have died as result of having been pregnant, a rate of 18.2 pregnancy-related deaths per 100,000 live births.
  • Black women continue to die from pregnancy-related causes at higher rates than their peers: Black, non-Hispanic women were five times more likely to die of pregnancy-related causes than White, non-Hispanic women.
  • Leading Causes of Pregnancy-Related Death were:
    • Embolism (20%)

    • Hemorrhage (20%)

    • Mental health conditions (15%)

  • Many of these deaths are preventable: When analyzing each case, the report concluded that 78% of these deaths were preventable and that 100% of the deaths caused by hemorrhage, mental health conditions, and cardiomyopathy were preventable.
  • Discrimination contributes to these deaths: in 46% of all pregnancy-related deaths, discrimination was identified as a probable or definite circumstance surrounding the death.
  • Deaths most often occurred within six weeks of pregnancy: Over half (51.2%) of pregnancy-related deaths occurred within six weeks of pregnancy – meaning women frequently died when pregnant or shortly after delivery/birth.
  • Cesarean delivery has a higher correlation with pregnancy-related death than vaginal delivery: women who had a cesarean delivery were 1.7 times more likely to die of pregnancy-related causes than women who delivered vaginally.

Co-Chairs of the NYS Maternal Mortality Review Board, Dr. Vanessa M. Barnabei, Dr. Christopher Glantz, and Dr. Amanda Victory said, "On behalf of the New York State Maternal Mortality Review Board, we are proud to contribute to the Department's published findings detailing the issues surrounding maternal mortality in New York. More importantly, through our work and recommendations, we are working to pave a path towards new solutions that address disparities in access to care and services inherent to maternal health outcomes. We thank the State's Department of Health for their commitment and collaboration in our efforts to greatly improve the health and safety for each and every pregnant New Yorker and their families statewide."

Cheryl Hunter-Grant, Chair of the NYS Maternal Mortality & Morbidity Advisory Council and former Executive Director of the Lower Hudson Valley Perinatal Network said, "Today's newly released report by the New York State Department of Health provides actionable insights to address systemic inequalities rooted in maternal mortality evidenced statewide. The work of the Department of Health's Maternal Mortality Review Board and Advisory Council continues, putting forward recommendations and building solutions that create safer birth experiences for New York families to directly improve health outcomes."

Dr. Wendy Wilcox, NYS Maternal Mortality Review Board Member and Chief Women's Health Officer, NYC Health + Hospitals said, "It is so poignant for the New York State Maternal Mortality Review Board's report to be released during Black Maternal Health Week. The work of the Review Boards has been incredibly heavy, yet necessary. Every case of maternal mortality in New York is examined in order to identify the cause and circumstances of the death, so that we may take meaningful action to reduce what has regrettably become a public health emergency. We must remember the women who have died during pregnancy or up to one year postpartum; as they left behind grieving families and communities. We humbly do this work in their honor."

Dr. Camille Clare, NYS Maternal Mortality Review Board Member, ACOG District II Chair, and Downstate Health Sciences University and Professor of College of Medicine and School of Public Health said, "Today's historic report helps us spotlight and address the critical urgency of improving maternal health outcomes statewide. The findings and recommendations will help to reduce racial disparities and advance policies and healthcare services needed to support New York families during pregnancy and the postpartum period."

Based on these findings, the Maternal Mortality Review Board (MMRB) concluded that structural racism and its impact on birth outcomes must be addressed through an integrated approach that reaches the healthcare system across New York State. Additionally, the report recommended measures such as expanding postpartum Medicaid coverage for one year after birth, especially for those eligible only during pregnancy; instituting home visiting programs from a nurse or paraprofessional within two weeks of delivery to provide education and one-on-one support to families, including on infant care and the warning signs of postpartum complications; the integration of community-based resources, particularly for those with health conditions or who have difficulty accessing follow-up care, including through doulas, visiting nurses, community health workers/patient navigators, telehealth visits/support, and remote monitoring where available; and the critical importance of the continuity of care for pregnant or recently pregnant New Yorkers who are treated by multiple doctors both during the pregnancy and afterwards. These recommendations address ongoing challenges reflected in similar trends found in the latest study from the National Center for Health Statistics, which reported that the number of maternal deaths rose 14 percent to 861 in 2020 from 754 in 2019 – signaling that COVID-19 has only exacerbated the need to urgently address maternal mortality.

Following decades of decline, the maternal mortality rate in the United States began climbing in the 21st century and now ranks among the worst for developed nations. For many years, New York State's maternal mortality rate mirrored that increase. In recent years, this trend has begun to reverse following the State Department of Health's efforts. Recent initiatives include updates to the New York State Regional Perinatal system, increased investment in home visiting programs, support for the New York State Perinatal Quality Collaborative (NYSPQC), and the creation of the New York State Maternal Mortality Review Board (MMRB) and Maternal Mortality & Morbidity Advisory Council (MMMAC) in 2019. Other work to better health outcomes for New York mothers and families include the New York State Obstetric Hemorrhage Project, the New York State Opioid Use Disorder in Pregnancy & Neonatal Syndrome Project, and the New York State Birth Equity Improvement Project. Through these initiatives, the Department works directly with hospitals and birthing facilities to optimize patient care, offer increased training for staff, and institute systemic changes to reduce structural racism. The Department has also improved access to care with funding for additional community health workers and evidenced-based home-visiting programs that help connect pregnant and new families to the support networks they need.

The Department is already working to expand on this report with data from 2019 – 2020.

The full report is available here.