/ /

  • linkedin
  • Increase Font
  • Sharebar

    Maternal mortality statistics


    Maternal Mortality Review Committees

    For almost 100 years, many states and jurisdictions supported the creation of local Maternal Mortality Review Committees (MMRCs) whose jobs have been to bring greater clarity to the numbers and causes of maternal death nationwide. These committees may have uncovered valuable information but the ability to do comprehensive analyses across multiple agencies and populations was seriously impaired by the independence of the committees, the uncoordinated nature of data collected, and the different collection formats used. Some areas did not have resource committees at all, making it impossible to draw complete conclusions nationwide.

    In 2015, a project called “Building U.S. Capacity to Review and Prevent Maternal Deaths” worked with the CDC and the Association of Maternal and Child Health Programs (AMCHP) to unite the efforts of the different MMRCs and collect data on maternal deaths in formats that are both consistent and comparable. This platform is called the Maternal Mortality Review Information Application (MMRIA, or “Maria”). The study started with the MMRCs in Colorado, Delaware, Georgia and Ohio. Data were entered by these states into the central Maternal Mortality Review Data System (MMRDS) which is held by the CDC. The focus of the centralized data collection was to “demonstrate the use of standardized review committee data for understanding the preventability, critical factors that contribute to death, and best opportunities for reducing pregnancy-related deaths, rather than trends in mortality over time.”4

    When a case of possible maternal death is identified, the MMRCS utilizes the services of a variety of health professionals (from areas such as public health, obstetrics, gynecology, nursing, midwifery, forensic pathology, mental and behavioral health, social workers, patient advocates) and a wide range of records - medical and non-medical, ante- and post-partum; informant interviews, social service records, etc. -  to build a narrative for each case that covers all aspects of the patient’s personal experience throughout her pregnancy, up to her death. When complete, each case is analyzed by committee to determine:

    1. Was the death pregnancy-related? The patient’s cause of death and any relation to pregnancy is assigned to 1 of 4 categories:  Pregnancy-Related, Pregnancy-Associated but NOT Related, Not Pregnancy-Related or Associated, Unable to Determine if Pregnancy-Related or Associated (Table 1).
    1. What was the cause of death? This information is obtained from the PMSS-MM and acts as an informational link between the PMSS-MM records and the MMRIA, promoting consistency between the systems.
    1. Was the death preventable? If the committee determines that reasonable changes in any 1 of 5 areas — to the patient, provider, community, facility or systems of care — might have prevented the death, then the death is considered to be preventable. The committee also has the option of documenting the degree of preventability assigned, from “none” through 4 levels, to “strong.”
    1. What were the critical contributing factors to the death? Contributing factors are assigned to 1 of 5 areas – again, to the patient, provider, community, facility or systems of care. Each factor is assigned to an explanatory class category, such as delays, adherence, lack of knowledge, etc., with a concise description of the specific factor.
    1. What are the recommendations and actions that address the contributing factors? Any actions or recommendations that might have prevented or contributed to the prevention of this specific death are identified, with information about who should initiate action, when the action should be initiated, and a description of the action itself.
    1. What is the anticipated impact of those actions if implemented? The MMRCs assign a specific level of prevention to each recommendation to determine whether an action would prevent the contributing factor before it occurred (primary prevention), reduce the impact of a contributing factor that has occurred (secondary prevention), or reduce the impact or progression of an ongoing contributing factor (tertiary prevention). The recommendations are then prioritized, with those supporting primary prevention, usually, as the higher priority.


    What comes next

    In 2016 over 30 states were contacted to define ways to integrate them into the MMRDS and identify their individual data needs. Because of those interactions, project staff have begun to add other information to the system, such as details about suicide, mental health criteria, drug abuse, and partner abuse. Partnerships with Violent Death Reporting systems in different states have also been initiated. The addition of information about these challenging issues placed in the context of pregnancy will provide an even more complete image of what is killing our nation’s mothers and, hopefully, guide us in our search for tools and techniques to reduce the number of these unfortunate deaths. 



    1. MacDorman, Marian F. PhD; Declercq, Eugene PhD; Thoma, Marie E. PhD. Trends in Maternal Mortality by Sociodemographic Characteristics and Cause of Death in 27 States and the District of Columbia. Obstetrics & Gynecology: May 2017 - Volume 129 - Issue 5 - p 811–818 doi: 10.1097/AOG.0000000000001968

    2. Trends in maternal mortality: 1990 to 2015: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015.

    3. Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, et al. Global, regional, and national levels and causes of maternal mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. 13;384(9947):980-1004. doi: 10.1016/S0140-6736(14)60696-6. Epub 2014 May 2. Erratum in: Lancet. 2014 Sep 13;384(9947):956. PMID:24797575

    4. Maternal Mortality CDC 2017. Report from Maternal Mortality Review Committees: A View into Their Critical Role. https://www.cdcfoundation.org/sites/default/files/files/MMRIAReport.pdf  Accessed December 20, 2017


    You must be signed in to leave a comment. Registering is fast and free!

    All comments must follow the ModernMedicine Network community rules and terms of use, and will be moderated. ModernMedicine reserves the right to use the comments we receive, in whole or in part,in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

    • No comments available


    Latest Tweets Follow