Maternal Death Reviews Get Political as State Officials Intrude

Every state has a committee of medical and public health experts tasked with investigating deaths that occur during and after pregnancy. But as data paints a clearer picture of the impact that state policies such as abortion bans and Medicaid expansion can have on maternal health, leaders in some states are rushing to limit their review committee’s work – or halt it altogether.

In November, Georgia officials dismissed all 32 members of the state’s maternal mortality review committee after investigative reporters used internal committee documents to link the deaths of two women to the state’s six-week abortion ban. In September, Texas announced its committee would not review 2022 and 2023 maternal deaths – the two years immediately following its near-total abortion ban. And two years ago, Idaho effectively disbanded its committee when conservative groups went after members for calling on the state to extend Medicaid coverage for postpartum women.

The maternal mortality rate for U.S. women is far higher than in any other high-income country, and Black women are more than twice as likely to die during pregnancy or after birth than the national average. Research has shown that most of these maternal deaths are preventable.

State officials have given varying reasons for their decisions. Sanders has called an extension of postpartum Medicaid "duplicative" because Arkansas has other insurance options. The maternal mortality review committee chair in Texas said the panel would skip a full review of the 2022 and 2023 deaths in order to offer analysis and recommendations based on the most recently available data. And Georgia’s state health officer said she dismissed committee members because they violated state law by sharing confidential information. Georgia plans to replace them with new appointees.

Charles Johnson, an Atlanta father of two whose wife, Kira, died in 2016 after a routine cesarean section and who has advocated for maternal health committees, is dubious. He said the dismissal of the Georgia panel appears to be "an attempt to retaliate for exposing some of the unfortunate outcomes of Georgia’s laws."

"The only role politicians and politics should have in this work is to support the committees and make sure they have the resources needed to do their job," said Johnson, who founded a nonprofit in his wife’s memory, 4Kira4Moms, and in 2018 testified before Congress to push for a measure supporting the creation of more state committees. It was signed into federal law that year.

Recommendations Lead to Change

While every state has a maternal mortality review committee, often abbreviated to MMRC, many of them were established just in the past decade, as state and federal officials focused attention on the nation’s high maternal death rates.

These committees perform comprehensive, deep-dive reviews of any deaths in the state that occur during pregnancy or within the year following a pregnancy. The committees typically comprise a mix of professionals including obstetricians, nurses, public health officials, forensics experts, behavioral health providers, and community advocates. They issue public reports that highlight their findings and make recommendations for how the state can prevent future deaths.

"Being able to answer questions with hard data is really important for informed policymaking," said Jennifer Callaghan-Koru, an associate professor at the University of Arkansas for Medical Sciences and the research director at the Arkansas Perinatal Quality Collaborative.

‘An Abuse of Power’

Last year, the investigative news outlet ProPublica obtained internal documents from Georgia’s MMRC that found two Georgia women died preventable deaths in 2022 after they couldn’t access legal abortions and timely care. Georgia law prohibits abortion after six weeks of pregnancy.

Dr. Kathleen Toomey, commissioner of the Georgia Department of Public Health, said in November that she dismissed the committee members because confidential information provided to them was "inappropriately shared" with the ProPublica reporters, violating state law and the confidentiality agreement that committee members must sign.

The state’s investigation never determined whether a committee member, or someone else, leaked the documents.

"I am concerned that this will continue to happen in other places," said Johnson, the Atlanta father. "I think that Georgia demonstrated an overreach and abuse of power that other states and other state medical directors may not have been aware they have."

An Arkansas Workaround

Arkansas is the only state in the nation that hasn’t taken steps to extend its Medicaid coverage to one year postpartum for low-income women. Nationally, researchers and advocates have stressed the importance of continuing insurance coverage after birth because more than half of pregnancy-related deaths in the U.S. occur in the year following a pregnancy, and Medicaid covers about 40% of births.

In recent years, Arkansas’ maternal mortality review committee has recommended postpartum Medicaid extension as a way to reduce maternal deaths.

But the governor remains staunchly opposed.

"[W]e want to make sure that we are transitioning women to coverage that already exists in the state," Sanders said during a March 2024 news conference. "I don’t believe creating a duplicative program just for the sake of creating a program is actually going to fix the issue. We already have so many women who aren’t taking advantage of the coverage that exists."

Conservative Pushback

Last March, Idaho lawmakers, led by Republican former House Majority Leader Megan Blanksma, reinstated its maternal mortality review committee.

Prior to that, Idaho was the only state without a maternal mortality review committee after lawmakers in 2023 effectively disbanded it by not renewing legislation. At the time, the Idaho Freedom Foundation and other conservative groups blasted the state’s MMRC for recommending postpartum Medicaid extension. State lawmakers tabled the bill in part over concerns over the cost of extending pregnancy Medicaid.

Conclusion

The politicization of maternal mortality review committees has become a pressing concern for advocates and experts, who fear that state officials are compromising the independence and integrity of these committees. As the debate continues, it is crucial to remember that every life lost during or after pregnancy is a preventable tragedy, and that policymakers must take a multifaceted approach to address the root causes of maternal mortality.

FAQs

Q: What is a maternal mortality review committee?
A: A maternal mortality review committee is a group of medical and public health experts tasked with investigating deaths that occur during and after pregnancy.

Q: Why are these committees important?
A: These committees are important because they help identify the causes of preventable maternal deaths and provide recommendations for how to reduce the risk of maternal mortality.

Q: Why is the politicization of these committees a concern?
A: The politicization of these committees is a concern because it can compromise the independence and integrity of the review process, potentially leading to incomplete or inaccurate information being presented to policymakers.

Q: What can be done to address the issue of maternal mortality?
A: A multifaceted approach is needed to address the issue of maternal mortality, including extending Medicaid coverage for postpartum women, improving access to healthcare, and addressing the social determinants of health.