State strategies for preventing pregnancy-related deaths : a guide for Moving Maternal Mortality Review Committee data to action

Maternal mortality is a devastating tragedy that no family or community should have to endure. Opportunities to eliminate maternal mortality can be best identified by multidisciplinary Maternal Mortality Review Committees (MMRCs) at the stateor jurisdiction-level (hereafter referred to as state), inclusive of representation by clinical and non-clinical experts that serve populations disproportionately affected by maternal mortality. MMRCs provide an understanding of factors that contribute to maternal mortality within the unique contexts of the states and communities where these persons lived. MMRC data can be a driving force for prioritizing recommendations and formulating strategies that can prevent maternal mortality.Suggested citation: Centers for Disease Control and Prevention. (2022). State Strategies for Preventing Pregnancy-Related Deaths: A Guide for Moving Maternal Mortality Review Committee Data to Action. Atlanta, GA: National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention.State-Strategies-508.pdf20221163

Advancing Maternal Health Equity in Southern States: What Are Medicaid Programs Doing and What More Could They Do?

The US is facing a severe maternal morbidity and mortality crisis, and Black women and other women of color are at particularly high risk. Maternal mortality is also higher in the South than in other regions. Given evidence that abortion restrictions are associated with higher maternal mortality, such risks could grow under the recent Supreme Court ruling overturning Roe v. Wade, especially in the South, where in many states abortion is now severely restricted. With more than 40 percent of all births nationally, 65 percent of births among Black women, and 59 percent of births among Hispanic women covered by Medicaid, state Medicaid policies and practices have the potential to improve maternal health and reduce racial and ethnic inequities in maternal health outcomes.For this study on Medicaid and maternal health, we conducted interviews with national experts, a national policy scan, and case studies in three Southern states (Georgia, Louisiana, and Texas) that are using various approaches to promote improvements in maternal health care for their Medicaid populations. We sought to identify facilitators of and barriers to maternal health equity and promising programs and policy levers that could advance maternal health equity to inform approaches in other Southern states

An Examination of the Maternal Health Quality of Care Landscape in India

India has made significant strides in maternal health over the past several decades, reducingits maternal mortality ratio (MMR) from 556 to 174 maternal deaths per 100,000 live births from1990 to 2015 (World Bank 2016a). Policies and initiatives to increase access to maternal healthservices largely account for this progress. However, the rate of improvement has slowed, and thecountry continues to contribute almost one-quarter of maternal deaths globally (Nair 2011). Inaddition, India is home to a high but difficult to measure rate of so-called near-miss maternaldeaths that often lead to maternal morbidity. Although the incidence of maternal morbidity inIndia is largely unknown due to the country's lack of diagnoses and under-reporting, it isestimated that millions of Indian women experience pregnancy-related morbidity; the GlobalBurden of Disease estimates that India contributes one-fifth of the disability-adjusted life yearslost globally due to maternal health conditions (World Health Organization 2008). These patternssuggest there is still progress to be made in maternal health in India.The John D. and Catherine T. MacArthur Foundation seeks to continue its more than 20-year history supporting population and reproductive health in India and accelerate the country'sadvancement in maternal health. It has chosen to fund a three-and-a-half-year grantmakingstrategy to improve maternal health quality of care, which has emerged as a key means to furtherreduce MMR and related outcomes. This review is intended to describe current issues andinterventions in the delivery of maternal health care and provide a backdrop for the Foundation'sgrantmaking effort

Reducing Implicit Bias: Evaluating Cultural Humility and Mindfulness Practices in the Perinatal Microsystem

Problem: In one perinatal microsystem, an assessment revealed 49 reported events that alleged perceived bias occurred over a one-year period. This project aims to address implicit bias and educational solutions to improve communication and create a culture of humility and equity. Context: The setting was an urban hospital within a large non-profit healthcare organization. The improvement team included registered nurse champions, obstetrical technicians, midwives, physicians, managers, and an educator. Intervention: A virtual interactive education session for a multidisciplinary volunteer group (n=18) was introduced followed by five weekly follow-up discussions. The education focused on translating the cultural humility theory (Foronda, 2020) into clinical practice. Two tools were integrated into the education sessions: 1. the 5 R’s (reflection, respect, regard, relevance, and resiliency) and 2. the Quick Coherence technique (Buchanan & Reilly, 2019). Measures: One primary outcome measure was defined as the percentage of participants (n=18) who completed both the pre and post cultural humility scale. The target was defined as 80% completion. The second outcome measure calculated the number of healthcare team members (n=18) who increased their ability to perform the Quick Coherence technique. The target was defined as 80% and measured via self-reports. Three process measures included 1. Percentage of learning needs assessments completed (n=18; target=80%); 2. Percentage of volunteers (n=18; target=80%) who completed initial education session; 3. Percentage of volunteers (n=18; target=65%) who completed all 6 education sessions. Two balancing measures were included and monitored: 1. the number of escalation events (target=weeks); 2. Percentage rate of weekly participant dropouts. Results: The primary outcome resulted in 100% completion of both the pre and post cultural humility scale (n=18). The scores on the Cultural Humility Scale (Foronda et al., 2021) for three factors were relevant in the post education survey. Factor 1 (difference in perspective) indicated an increase in awareness of the different factors that may impact a shift in perspective. Compared to the pre-survey, Factor 2 (self-attributes) showed a decrease in three of four items reflecting the degree of flexibility, openness, and awareness related to cultural humility. Factor 3 (knowledge of cultural humility) scores increased in all 7 items concerning knowledge of cultural humility and beneficial teaching efforts. The second outcome measure resulted in 72% of team members who performed the Quick Coherence technique during the 6-week project. Results of process measures indicated 80% completion of learning needs assessment and 65% participant completion of 6 education sessions. Balancing measures indicated 2 escalation events over the 6-week project and a 50% dropout rate. Conclusion: A structured evidence-based tool such as the Foronda Cultural Humility scale is strongly recommended for integration into interdisciplinary team development and education initiatives across systems. This Cultural Humility and Mindfulness practice quality improvement project demonstrated promising results despite the competing priorities related to a global pandemic. Nurse leaders need to provide caregivers with tools to evaluate their own biases and to communicate more effectively to improve patient interactions and outcomes

From Silos to Synergy: How the Funding Landscape is Shifting for Maternal and Newborn Health, Justice, and Equity

There is no better gauge of the health of a society than the health of its mothers and children. Since 1990, there has been tremendous progress in reducing maternal and newborn mortality rates around the world. The number of maternal deaths decreased 44% between 1990 and 2015, the number of infant deaths decreased 55% from 1990 to 2018, and the number of deaths of children under 5 decreased 59% from 1990 to 2019. However, more than 800 women still die every day from preventable complications related to childbirth, and each year, 2.4 million babies do not survive past their first 30 days of life.Progress — or lack thereof — on maternal and newborn health can be attributed to a multitude of factors, including political will, the quality of the health systems infrastructure, availability of a skilled workforce, and numerous environmental conditions. Addressing these factors and implementing solutions undoubtedly requires funding. This report is intended to acknowledge and highlight the vital role that both philanthropy and organizations play in shaping the future of maternal and newborn health, as well as to provide insight as to how the funding landscape can be more efficient and impactful for all stakeholders.

Opportunities for Improving Communication Between Maryland Nurses and Black Health Patients

This qualitative, hermeneutic, phenomenological study was conducted to better understand how maternal health nurses in Maryland and Black women patients communicate. The study’s secondary objectives were to understand the communication procedures and leadership responsibilities within the state’s health services organizations (HSOs) and the nurses’ experiences with these topics. The patient-centered care conceptual framework was applied in this study to explore the high maternal mortality and morbidity health crisis affecting U.S. Black maternal health patients to discern the processes involved and determine whether potential communication as well as a lack of leadership roles and support could be contributing factors. The participants were 11 nurses from public hospitals and clinics throughout Maryland that have provided maternal health care in the state for at least 3 years. Interpretive coding was used to manually classify and organize the data for analysis. Iterative data analysis revealed five overall themes: (a) maternal health nurses experienced burnout, (b) maternal health nurses were challenged with cultural and health literacy barriers, (c) maternal health nurses fostered patient-centeredness, (d) maternal health nurses were key patient safety advocates, and (e) the need for more consistent HSO interdepartmental partnerships in delayed communication, interventions, and baseline care plan conformity. The findings of this study may lead to positive social change by providing a basis for understanding and addressing specific factors, such as access and delivery coordination, that may contribute to poor maternal health care outcomes and communication experiences between nurses, patients, and HSOs, improving Black maternal health outcomes

Impact of Coalition Building to Promote Maternal Infant Health Equity in the District of Columbia, Maryland, and Virginia

The health of women and babies is critical to creating a healthy world. Stratified data shows the overwhelming rates at which Blacks are affected more than Whites. Literature has shown that leveraging partnerships and community engagement are critical components of decision-making and can positively impact the health of communities. Through a direct observational study, the Community Coalition Action Theory was used to analyze the current structure of the March of Dimes Maternal Infant Healthy Equity Coalition. The study aimed to identify strengths and gaps and subsequently provide recommendations to advance the coalition work and promote maternal and infant health equity in the community. Thirty-eight hours of observation revealed the lead agency’s longstanding history and robust team of coalition members uniquely positioned themselves to address maternal and infant health equity in the service area. The observational study revealed there were no formalized bylaws guiding the work. Elements of the Community Coalition Action Theory’s associated constructs: processes, structures, assessment and planning, implementation strategies, and outcomes can be improved. By making a few modifications using published toolkits designed for coalitions, the March of Dimes Maternal Infant Health Equity Coalition can continue to build efforts using evidence-based coalition effectiveness strategies to improve local maternal and child health outcomes among racial and ethnic minority groups

What works? A review of actions addressing the social and economic determinants of Indigenous health

Introduction: The purpose of this paper is to review evidence relating to ‘what works’ to influence the social and economic determinants of Indigenous health, in order to reduce health inequities, and ultimately contribute to closing the life expectancy gap between Indigenous and non-Indigenous Australians. We outline a conceptual framework for understanding how social and economic determinants influence health and wellbeing, and identify a number of key determinants of health. We review evidence relating to how each determinant is associated with Indigenous health and wellbeing, and then consider specific actions designed to improve Indigenous outcomes in each of these areas in order to determine the characteristics of successful initiatives. Based on our conceptual framework, we link successful actions which result in positive outcomes for Indigenous Australians in each of the key determinants to ultimately improving health and wellbeing and contributing towards ‘closing the gap’ in health and wellbeing. We note that many actions we consider only aim to improve the situation for Indigenous Australians in regard to that specific area (for example, education, housing) and were not devised to take direct action to improve health, even though the evidence indicates that those actions may be likely to contribute to improved health over the longer term

Stillbirths: recall to action in high-income countries.

Variation in stillbirth rates across high-income countries and large equity gaps within high-income countries persist. If all high-income countries achieved stillbirth rates equal to the best performing countries, 19,439 late gestation (28 weeks or more) stillbirths could have been avoided in 2015. The proportion of unexplained stillbirths is high and can be addressed through improvements in data collection, investigation, and classification, and with a better understanding of causal pathways. Substandard care contributes to 20-30% of all stillbirths and the contribution is even higher for late gestation intrapartum stillbirths. National perinatal mortality audit programmes need to be implemented in all high-income countries. The need to reduce stigma and fatalism related to stillbirth and to improve bereavement care are also clear, persisting priorities for action. In high-income countries, a woman living under adverse socioeconomic circumstances has twice the risk of having a stillborn child when compared to her more advantaged counterparts. Programmes at community and country level need to improve health in disadvantaged families to address these inequities.Mater Research Institute – The University of Queensland provided infrastructure and funding for the research team to enable this work to be undertaken. The Canadian Research Chair in Psychosocial Family Health provided funding for revision of the translation of the French web-based survey of care providers.This is the author accepted manuscript. The final version is available from Elsevier via http://dx.doi.org/10.1016/S0140-6736(15)01020-

Finance and Payment Innovation: Improving Equity in Perinatal Care and Maternal and Infant Outcomes

While the U.S. spends approximately $111 billion per year on perinatal (prenatal, birth and newborn) care, maternal and infant health outcomes are among the worst of any high-income nation and racial disparities continue. Efforts to improve outcomes generally focus on coverage, health care delivery systems and payments. Many innovations and ideas have emerged in recent years. This brief will help stakeholders concerned with maternal and infant health in Michigan understand the strengths and weaknesses of payment reforms for maternity or perinatal care, costs, and outcomes, including their impact on equity. The role of Medicaid and the beneficiaries it covers are emphasized, including Michigan data and examples from other states' efforts. This work is based on information from published studies, efforts of federal and state agencies, and national expert recommendations. Maternal Child Health (MCH) leaders inside and outside of government can use this information to support the design and development of any proposed perinatal payment reforms