In 2010, 17.6 of every 100,000 live births in New York City resulted in maternal death from a pregnancy-related cause. According to Dr. Deborah Kaplan, assistant commissioner of New York City’s Bureau of Maternal, Infant, and Reproductive Health, that translates into about 30 deaths per year. And for every woman that dies, she says, “about 100 women almost die, and that’s about 2,500 to 3,000 women a year.”
Parse those numbers by race and they become even more startling. Severe maternal morbidity—almost dying from a pregnancy-related cause—is three times higher in black women than white women. Black women are 12 times more likely to die from a pregnancy-related cause. And although New York City has seen a decrease in the maternal mortality rate in recent years, that’s primarily due to reductions in deaths among white women—the racial disparity has increased.
In response to this data, the city formed a Maternal Mortality and Morbidity Review Committee (M3RC) over the winter to recommend ways to reduce those deaths, particularly among racial minorities. “The data from those reports is a call to action for the Health Department,” says Hannah Searing, co-chair of the committee. “And not just the data, but the disparities we found in the data when comparing black women and Hispanic women to white women.” The M3RC is one of only two committees at the city level, partly because of New York City’s unique relationship with the state Department of Health.
How does the committee determine recommendations?
The first step in the committee’s work is identifying any deaths or cases of severe morbidity that occurred any time during pregnancy or up to a year afterward. It meets four times a year to review these cases, looking at everything from vital records and prenatal records to autopsy reports. This helps the committee “develop a detailed case narrative, which summarizes the chain of events leading up to the death,” Searing explains.
Committee members are not only physicians and clinicians, but also experts in other areas of maternal care. “We have midwives, we have nurses, we have doulas, and we have people who work on community-based organizations that serve women of reproductive age,” Kaplan says. A wide variety of perspectives helps the committee understand the cases they look at more fully, giving them a “holistic understanding of the data that we can translate into actionable strategies.”
Once the committee has reviewed the cases, they deliberate on policy recommendations and meet twice a year with a steering committee. “They help us move the recommendations to action,” Searing says.
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First and foremost, the M3RC seeks to reduce maternal mortality and morbidity in New York City through making changes at the personal, community, provider, facility, and systems levels. It won’t make any recommendations until it’s collected a year of data, but Searing stresses the importance of using the data the committee collects to inform action. “That’s what we are about—doing something with the data,” she says.
Beyond policy recommendations, the M3RC is working with Merck for Mothers, which provided 1.8 million dollars in funding, to create a toolkit to help other committees incorporate severe maternal morbidity into their work. “They were partly interested in funding us because they saw we had the capacity, with some help from them, to develop a toolkit that could inform the work around the country,” Kaplan says.
What else is being done to reduce maternal mortality and morbidity?
While the committee collects and reviews cases, the city is focused on other initiatives aimed at reducing maternal mortality and morbidity.
“This has become a top priority of our agency and the data and the committee is a key tool that will inform recommendations going forward,” Kaplan says. “But we can’t wait for that. We have to move forward with what we know around improving women’s health.” One example she cited was their work helping hospitals review cases of severe maternal morbidity to improve care in those cases.
What actions might the committee recommend?
Although New York City won’t see policy implemented based on M3RC recommendations any time soon, states with similar committees have been modelling potential actions. Colorado tackled deaths from maternal mental health and substance use through a campaign with Postpartum Support International. Ohio trained rural hospitals in obstetric emergencies. When Florida sees large concentrations of cases, it sends bulletins to providers to alert them. All these steps were informed by the work of committees like New York City’s.
When the time comes for the M3RC to make its recommendations, Kaplan is confident that people will pay attention. “I feel like when we come out with our recommendation there’s going to be a credibility and a power to the recommendation,” she says.