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Will new maternal health legislation reduce deaths — or just delay action?

Will new maternal health legislation reduce deaths — or just delay action?

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Last month, Congress passed “landmark legislation” that will provide states millions of dollars to figure out why women are dying from pregnancy and childbirth-related causes, with the aim of preventing those deaths.

The legislation raises some crucial questions: Do we still not know why mothers are dying? Will more committees and recommendations really help? Perhaps. Despite the big reductions in deaths achieved in states such as California, experts say the law will help by prioritizing maternal deaths and providing local explanations to a broader crisis.

The bipartisan federal Preventing Maternal Deaths Act was signed into law late last year after reporting from ProPublica, NPR and others told the heartbreaking human stories behind America’s grim statistics for mothers. In the U.S., about 700 women die during pregnancy or within a year after pregnancy ever year, while 50,000 experience severe complications, according to the Centers for Disease Control and Prevention (CDC).

The risk of pregnancy-related deaths among black women is three to four times higher than among white women, a fact both Serena Williams and Beyoncé brought to public attention following their own harrowing childbirth experiences, including Williams’ description of how her medical team did not listen to her when she self-identified  potentially fatal blood clots in her own lungs the day after giving birth by emergency cesarean section.

Melinda Gates joined the chorus as well, promising this month to address these disparities in her 2019 annual letter.

Most of pregnancy-related deaths are preventable, according to a report published from nine different states’ Maternal Mortality Review Committees along with the CDC.

Enter the new law.

The law sets aside $12 million per year for five years for states to form committees to review pregnancy-related and pregnancy-associated deaths, and then develop and implement recommendations to improve the quality of maternal care. The CDC will help oversee the effort and collect data from the states.

About 35 states have review committees or are in process of forming them, according to ProPublica.

“The great value of having all the states doing maternal mortality reviews, will be this cataloguing of what’s going on with women’s health in the United States in a way we haven’t had before,” said Eugene Declercq, professor of community health sciences at the Boston University School of Public Health who sits on the Massachusetts committee.

While part of the law’s aim is to figure out why women are dying, California, which has had a committee since 2006, already knows. The state has taken action to reduce its rate of death and complications —the maternal death rate in California fell 55 percent from 2006 to 2013 — and has widely shared how other states could do the same.

The California Maternal Quality Care Collaborative (CMQCC), a private-public partnership with the state, has published easy-to-follow checklists and best practices that help clinicians save women suffering from preeclampsia, obstetric hemorrhage and other life-threatening conditions.

If California has the answers, why is this legislation needed?

“We’re unlikely to have major new understandings, but I think there are some important locality issues,” said Dr. Elliott Main, CMQCC’s medical director and the chair of the California Pregnancy-Associated Mortality Review Committee.

“The causes of maternal mortality do vary state to state, so it’s important to be able to localize what’s going on,” he said. “Starting a committee makes it a priority to do something. These cases, if you can turn them into powerful stories, it really helps with the change. Folks in Oklahoma or Texas don’t want to be driven by what happens in New York or California.”

Boston University’s Declrecq said the state review committees will first look at deaths of all women of reproductive age — without identifying individual patients, clinicians or hospitals — and determine which deaths were pregnancy-related. From there, they’ll try to determine if any given death was preventable, with the aim of making recommendations to the state from their findings.

He said that only about one-third of maternal deaths occur during labor and delivery or in the following week. About one-third occur during pregnancy and another third between about a week and one year after birth. The risks aren’t just about emergencies during labor.

“What we’re talking about is public health issues,” he said. “And that’s where you get into trickier issues around … whether it was preventable, for instance. We honestly end up with discussions like, ‘Well, if we had a really functional social system that identified these problems early on and got the woman care years before she got pregnant, then this life might have been changed.’”

Declrecq said the best outcome for this legislation may be much broader than maternal deaths, which make up about 1 percent of all deaths each year among women of reproductive ages. These deaths are on the rise in the U.S.

“If it’s the beginning of a systematic approach to dealing with women’s health, not just maternal deaths, but women’s health, then it can be a very promising base on which to build.”

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