State legislators are taking the maternal mortality crisis into their own hands

This story was originally published by The 19th.

As efforts to address the country’s maternal mortality crisis have stalled at the federal level, advocates and lawmakers are increasingly turning to statewide maternal mortality review committees to make progress — and try to save lives.

Guttmacher Institute, one of the nation’s largest reproductive health research organizations, reports that almost all states have a maternal mortality review committee that’s tasked with investigating pregnancy-related deaths and their causes and making prevention recommendations.

The Centers for Disease Control and Prevention recorded 1,205 maternal deaths in 2021, up from 861 in 2020 and 754 in 2019. The average maternal mortality rate that year was 32.9 per 100,000 live births. Black birthing people’s maternal mortality rate was 69.9 per 100,000 live births, compared to White birthing people’s rate of 26.6.

Guttmacher marks 2016 as a year of resurgence of interest in these review committees as attention on maternal mortality rose. Jennifer Driver, the senior director of reproductive rights at the advocacy group State Innovation Exchange, believes that the acknowledgement of maternal mortality as an issue — and one that disproportionately impacts Black women —  has resulted in an uptick in legislation to study or address the matter. She also believes state legislators are better equipped to address maternal health than their federal counterparts because of the rate at which legislation moves at the state level. 

“State legislators play a critical role in advancing and protecting reproductive rights. While often, folks look at Congress or the administration or the courts, what we know, especially in 2024, that all of those are really kind of stalled,” Driver said. “Because of the makeup of the Congress, and the way that politics has just been so polarized, very little legislation passes. And so there's only so much that Congress can do, whereas on the contrast, state legislators are on the front lines of this work. So much legislation moves faster.”

Democratic U.S. Reps. Lauren Underwood of Illinois and Alma Adams of North Carolina sponsored the Black Maternal Health Momnibus Act of 2021, which included bills to improve maternal health through several avenues, including researching and collecting data on maternal mortality and morbidity among minority groups. It did not pass, but there are efforts to pass state-level Momnibus bills. 

While the American Journal of Obstetricians and Gynecologists (AJOG) recently reported that maternal mortality rates may be overstated, “Maternal mortality rates among non-Hispanic Black women …  remained disproportionately high compared with other race and ethnicity groups.” A recent study found “stable rates of maternal mortality in the United States between the 1999–2002 and 2018–2021 periods, decreases in maternal deaths due to direct obstetrical causes, increases in maternal deaths due to indirect obstetrical causes, and large increases in the misclassification of nonmaternal and incidental deaths due to the use of the pregnancy checkbox.”

Despite the conflicting methods of tracking maternal mortality, state lawmakers — most of them women — are establishing new committees to study and assess maternal health outcomes and strengthening existing review panels. 

Here’s a look at what’s happening across the states:

In Georgia, Republican Rep. Lauren Daniel sponsored legislation to establish the Commission on Maternal and Infant Health to be made up of 14 members appointed by the governor, lieutenant governor and state Speaker of the House. The commission would spend two years assessing perinatal care in the state, making policy recommendations and determining how to measure effectiveness and quality of perinatal care. Perinatal care is parents’ and babies’ health before, through and after birth, according to the World Health Organization, which notes that, “Ensuring access to affordable and good quality of care throughout pregnancy and the perinatal period is essential to reducing the rates of complications and deaths related to pregnancy and childbirth.”

The bill was passed by the House and is being read by the Senate. The state’s maternal mortality review committee reported that there were 35.6 pregnancy-related deaths per 100,000 live births in the state between 2019 and 2021. 

Idaho became the only state without a maternal mortality review committee after the previous ended due to legislation it was tied to expiring last year. House Majority Leader Megan Blanksma, a Republican, sponsored legislation to reestablish the state’s committee to investigate and report on maternal deaths to the legislature annually. This time around, the committee would be a part of the Idaho Department of Medicine instead of the state Department of Health and Welfare and would not rely on federal funds.

The bill was passed in a 52-17 vote in the state House, 25-10 vote in the state Senate, signed into law on March 19 and will take effect on July 1. Idaho’s most recent maternal mortality data collected by the former committee in 2021 showed 17 women died while pregnant or within a year of being pregnant — 15 of which were deemed preventable and nine of which were pregnancy related. 

In Tennessee, Democratic Sen. London Lamar put forth legislation to establish the Maternal Health Equity Advisory Committee to review maternal health data and make improvement recommendations to the state Department of Health. The 11-member committee would include representatives from East, Middle and West Tennessee and people from community-based organizations, such as doulas or midwives. Lamar said the organizations are a valuable addition to the already-established maternal mortality review committee, which consists of experts in pediatrics, OB-GYN, domestic violence, neonatology, maternal and infant health and other public health arenas. 

Lamar told The 19th that while the expertise of medical professionals is valued, “They're not on the ground in a way many of our community birthing organizations are, our doula organizations, our lactation specialist organizations. A lot of those organizations are built to do direct services to pregnant women on the ground on an everyday basis.”

The bill passed 31-0 in the state Senate as amended on March 14, passed 78-6 in the state House on April 18 and sent to the governor.  

Tennessee’s maternal mortality rates have increased since 2020, with reportedly 53 women dying from pregnancy-related causes — 79 percent of which were deemed preventable. 

This past February, Republican Rep. Kim Moser of Taylor Mill, Kentucky, sponsored state Momnibus legislation to establish the Kentucky maternal and infant health collaborative to address perinatal mental health disorders, provide lactation consultation and equipment and teach mothers about breastfeeding. The legislation also expands a state program to permit at-home visitations from trained service providers up to three years after the baby’s birth. Momnibus passed 90-0 in Kentucky’s House and now sits with the state Senate who has proposed amendments. In 2021, Kentucky’s maternal mortality review committee reported that there were 61 maternal deaths from 2013-19.

Last year, North Carolina state Sen. Natalie Murdock, a Democrat, sponsored the state’s Momnibus legislation that would establish a grant for community-based birthing organizations and implement implicit bias training programs for maternal health professionals. This was Mudock’s second attempt to pass Momnibus legislation after being inspired by the effort at the federal level. She has also sponsored and supported other maternal health legislation. 

“It is tied to reproductive justice and a birthing person's ability to have freedom over their own body. We have found that maternal care has decreased as a result of OB-GYNs leaving our state because of our abortion ban,” Murdock said. “As the Supreme Court has said, abortion is a state-level issue, but it’s intricately connected to maternal health. If you don't have enough OB-GYNs, you're not getting that prenatal care. It's making it more difficult for women to have children. It's so much more than abortion. It's about overall reproductive justice and freedom.”

North Carolina’s maternal mortality review committee reported that there were 76 pregnancy-related deaths between 2018-19 — 85 percent of which were preventable, and it was noted that discrimination due to factors including race, weight and incarceration history was a factor in 69.7 percent of the deaths.

While statewide committees signify “that there is an actual concerted effort to come together to deal with the issue,” Lamar said, establishing and strengthening them is only half the battle. “It's still up to the legislature and the departments to implement what they recommend and use the data that they produce to actually put forth legislation — or support legislation — that aligns with what's being said.”