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IHI has developed a number of tools and resources that can help provider organizations address maternal mortality.
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A Shameful Outlier: Maternal Mortality in the US Is Rising, But Improvement Science Can Help

By Jeff Rakover | Wednesday, November 30, 2016
maternal-mortality

The world has seen dramatic improvements in maternal mortality in recent years. From 2000 to 2015, the global death rate fell by more than a third for complications during pregnancy or childbirth.

A notable exception to this trend? The United States.

A recent study found that maternal mortality has risen by 26.6 percent from 2000 to 2014 in 48 states and the District of Columbia. Among nations in the Organization for Economic Development, only Mexico has a higher maternal mortality rate.

Why? Numerous factors likely explain the US increase, including increases in maternal age, chronic illnesses during pregnancy — such as hypertension, diabetes, and cardiovascular disease — and substance use in some communities.

Promising Efforts to Combat Maternal Mortality

Despite this discouraging news, there is hope: National and local efforts are trying to address the health and social conditions that that jeopardize women’s lives in pregnancy and childbirth.

Here are a few promising efforts:

  • The Council on Patient Safety in Women’s Health Care has developed maternal safety “bundles” to address some of the causes of maternal death, such as obstetric hemorrhage, severe hypertension/eclampsia, and venous thromboembolism. The Council has developed tools and resources that can be used by facilities across the US to address maternal mortality. “The maternal safety bundles and the resources aligned with them, provide a core structure for facilities to build their maternal safety programs on,” says Sue Gullo, IHI’s Director of Maternal and Infant Health. “It’s also a powerful demonstration of bringing together many different experts in the field.” These resources are publicly available at safehealthcareforeverywoman.org.
  • The Alliance for Innovation in Maternal Health (AIM) offers the largest national collaborative effort to combat US maternal mortality and severe maternal morbidity on the state level. AIM is a national partnership of organizations working to reduce maternal mortality by 1,000 deaths and severe maternal morbidity by 100,000 by 2018. AIM partners include the American College of Nurse Midwives, the American College of Obstetricians and Gynecologists, and several other professional societies and government bodies. AIM provides technical assistance to promote adoption of the bundles in numerous states, such as Oklahoma, Maryland, and Louisiana.
  • At the same time, and in parallel, Merck for Mothers has supported numerous efforts to promote maternal health and safety across the United States. Merck for Mothers is a 10-year $500 million initiative focused on improving the health and well-being of mothers during pregnancy and childbirth. In the US, Merck funds programs to support maternal health and reduce adverse outcomes in 16 states. For example, Merck for Mothers has funded the Camden Coalition of Healthcare Providers in New Jersey. Their program uses community health workers to support maternal health and improve health system navigation for pregnant and postpartum women.
  • Maternal mortality and severe maternal morbidity do not affect all US women equally. According to the Centers for Disease Control and Prevention, the rate of pregnancy-related death for African-American women was almost four times that of white women in 2011-2012. The Council on Patient Safety for Women’s Health Care is developing a “bundle” focused on addressing these disparities. The “Black Mamas Matter” toolkit by the Center for Reproductive Rights focuses on both policy and clinical interventions to reduce the disparity, including quality-of-care strategies like improving the response to inpatient obstetric emergencies, improved access to perinatal care, and environmental factors related to structural racism.

In general, efforts at the state and local levels have helped pave the way for the national efforts. California has been a pioneer in implementing and scaling efforts to improve maternal death rates and has seen impressive results. Through efforts focused on two leading preventable causes of maternal death and severe maternal morbidity — obstetric hemorrhage and preeclampsia — the California Maternal Quality Care Collaborative (CMQCC) has supported efforts to decrease their overall rates of maternal mortality to levels comparable to those in Western Europe.  

Taking Action

IHI has developed a number of tools and resources that can help provider organizations address maternal mortality.

IHI’s work has found that interventions are more likely to succeed if they link with population health approaches to perinatal care, such as the maternity medical homes, integrated models of perinatal care and substance use treatment, and improved contraceptive decision-making and access

Overall, the US lags behind in implementing safety bundles and other evidence-based practices. Improvement science offers the tools to drive real change on the ground; continued research offers an ongoing pipeline of change ideas.

Together, providers, policymakers, advocates, and others in the quality improvement community must garner the will and organization to finally bend this curve and reverse a shameful trend.

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