By Melinda Young
EXECUTIVE SUMMARY
Maternal mortality review committees (MMRCs) are facing changes that could affect how maternal deaths are investigated and reported. This could lead to fewer initiatives to lower maternal mortality and morbidity rates and also could mask increases in abortion-ban states.
- Georgia dismissed all members of its MMRC after ProPublica published articles about two Georgian women who died because of the state’s abortion ban. The state said the committee was dismissed because someone shared confidential information with an outside individual.
- The MMRC in Texas decided to not review any maternal mortality cases in 2022 and 2023, despite those being years when women’s pregnancy care was changing because of the state’s abortion bans.
- Idaho placed its MMRC under the state board of medicine, which licenses doctors, and the board decided not to cover cases in 2022 in its first 2025 report.
Georgia’s action to dismiss all members of its maternal mortality review committee (MMRC) is part of an emerging pattern of states with abortion bans seeking ways to not collect, investigate, or disclose information about maternal deaths and injuries.1-3 Another pattern in states with extreme abortion bans is doctors refusing to perform any abortion procedures for medical management of miscarriages and other pregnancy problems — even when this would have been the standard treatment before the 2020s.
There is a larger potential problem if the new federal administration’s promised cost-cutting extends to cutting federal funding for the MMRCs’ work. This could leave MMRC funding for maternal mortality investigations up to the states. States may not want to investigate changes in maternal morbidity and mortality if increases in women dying or being injured from pregnancy are related to worse maternal care in abortion-ban states. There already is evidence of hospitals not providing dilation and curettage (D&C) procedures for miscarriage treatment, out of fear of repercussions from anti-abortion laws.4
“Reproductive health and women’s healthcare are already underfunded, under-resourced, and under-studied,” says Sara Neill, MD, MPH, an associate program director of the OB/GYN Residency Program and Complex Family Planning Specialist at Beth Israel Deaconess Medical Center in Boston. Neill also is an instructor in obstetrics, gynecology, and reproductive biology at Harvard Medical School in Boston.
When MMRCs change to limit investigations, roll back the committees’ work, or have reduced funding, the committees’ ability to monitor maternal mortality and respond to any increase in maternal morbidity and mortality becomes even more difficult, Neill says. “We won’t see these deaths or monitor it without these committees,” she adds. “Imagine asking for more funding [to lower maternal deaths] without data on what’s happening.”
“I’m deeply concerned about the rolling back of maternal mortality review boards, which were created to figure out underlying causes of maternal mortality and to prevent further maternal mortality,” says Roselle Bleck, MD, MPH, an OB/GYN and researcher practicing in New York, NY.
Changing MMRCs is problematic, particularly because the decisions to change them appear to have been made in reaction to very important cases of women dying because of abortion bans and not being able to access standard medical care, Bleck adds. “I’m worried we are going backwards and seeing worsening care as a result,” she says.
“It’s really curious,” says Anita L. Nelson, MD, professor of obstetrics and gynecology at Western University of Health Sciences in Pomona, CA. Nelson also is a professor emeritus at the David Geffen School of Medicine at the University of California, Los Angeles.
The avoidance of abortion procedures like vacuum aspiration or dilation and curettage suggests something that goes beyond abortion bans, which prohibit physicians, women, and others from having an elective abortion procedure Hospitals that refuse to treat women for excessive bleeding and/or infections caused by miscarriages or medication abortions are needlessly imperiling women’s lives, she notes. And they are part of a pattern of mistakes and quality breaches that can lead to women’s deaths in situations where this is easily preventable, Nelson adds.
It is not just opposition to abortion that leads to deadly mistakes. It is also the lack of obstetric services in large swaths of the nation. “We have bleak deserts and counties with no obstetrical care services,” Nelson says.
This is where maternal mortality boards may fail women by not always collecting information about pregnant women who had to drive several hours for emergency care. “We need to show the impact of what maternal mortality is,” Nelson says. “If women are going to be second-class citizens, then we just don’t care [about their lives].”
Actions to dismiss Georgia’s MMRC came after the nonprofit investigative journalism organization ProPublica published articles about two women who died because of the state’s abortion ban. The women — both mothers and Black — had taken abortion medication and experienced problems. One did not go to the hospital out of fear of being arrested, and she died at home. The other woman did go to an emergency department but was not treated effectively until it was too late to save her life.3 (See the article in the January 2025 issue about women who died in Georgia.)
Georgia Commissioner and State Health Officer Kathleen E. Toomey, MD, MPH, said in a letter, dated Nov. 8, 2024, that the committee was dismissed because confidential information “was inappropriately shared with outside individual(s).”3,5
Texas’ maternal mortality committee has decided to not review any mortality cases in 2022 and 2023.6,7 The Texas Department of State Health Services spokesperson Lara Anton told the Associated Press that “reviewing cases is a lengthy process and legislators have asked for more recent data.”7
Idaho reconstituted its review committee to place under the state board of medicine, which licenses doctors. The board planned to issue a report on Jan. 31, 2025, but will only cover cases in 2023, reviewing 2022 cases later.7
The data collected by MMRCs in some abortion-ban states have made it politically uncomfortable for groups that favor abortion bans. “We’ve made important strides in addressing maternal care because of information from MMRCs,” says Michael R. Kramer, PhD, MS, an epidemiologist and director of the Center for Rural Health and Health Disparities at Mercer University School of Medicine in Macon, GA. (See “How Are Maternal Deaths Counted and Investigated?” in this issue.) “So, it would be shameful and a shame to lose the information we’re getting from MMRCs,” Kramer says.
For example, Georgia’s MMRC helped the state identify maternal deaths in the postpartum period that were past the six-weeks postpartum point when Medicaid coverage stopped for many pregnant people, he explains. “There was a high number of women dying in the postpartum period, and they had not made a postpartum appointment because they lost their Medicaid eligibility, and they fell off their insurance,” Kramer says. “So, the state expanded pregnancy Medicaid to 12 months postpartum.” This change in Georgia was approved in October 2022 and is expected to reduce maternal mortality.8
Another threat to MMRCs involves funding, which was expanded with an appropriation by Congress to the Centers for Disease Control and Prevention (CDC) in 2018. The extra funds were used to help MMRCs with their investigations. If a new administration decides to cut this funding, it could lead to uncounted, unknown maternal deaths. “Before the CDC funded MMRCs, there were still maternal deaths, but we didn’t know this because they weren’t collecting [as much data],” Kramer says.
Without federal funding, it is possible maternal deaths will continue and even increase, and there would be no tools to find identifiable modifiable causes of preventable maternal mortality, he adds. “There are fixable things that could make a difference in the future, and some of those might be how we deliver care, and some are broader things like access to care,” Kramer explains. “The way to prevent maternal mortality is to understand preventable causes.”
Changes to MMRCs are happening at the same time there is evidence that maternal mortality rates are rising in states with extreme abortion bans, such as Texas. The rate of maternal mortality cases in Texas increased by 56% from 2019 to 2022.9
If MMRCs are given a narrower focus as a political reaction to increased maternal deaths due to abortion bans, this is problematic. For instance, if there are delays in care for pregnant women in medical crisis because patients live in maternity deserts, which have grown in response to OB/GYNs leaving abortion-ban states, then these might not be counted by MMRCs that are narrowly focused on direct biomedical obstetric causes of death.
“Say a woman died because she couldn’t make it to a hospital,” Kramer says. A pregnant woman could die of a heart attack that she would not have had if she had been able to end her pregnancy. Or a woman has a miscarriage and is refused treatment with misoprostol and is sent home because she is not sick enough to meet the state’s abortion exception standard, he adds. MMRCs would be able to analyze these deaths and determine the root cause of them unless the board includes a narrow definition of maternal deaths.
“There are ways that who is on the committee, and how they think about cause and effect, matters in how that state reports its maternal mortality,” Kramer explains. “Say they had X deaths in a year, but say, ‘we think only a handful are preventable’ — that’s a subjective opinion that is hopefully only made by people who have expertise and not by someone putting their fingers on the scale.”
If states with abortion bans say these maternal deaths that would not have occurred before the state had its abortion ban are not preventable because the state’s abortion ban is a legal prohibition of what was standard medical treatment, then those maternal deaths may not be reported as preventable. “Preventability should be agnostic to the state [and its laws]; it’s what could theoretically be prevented,” Kramer says. “But no one is enforcing how a committee is [measuring] it. CDC does not have authority over the states but provides funding and consultation support. States have a lot of power in how they do this, and that’s potentially what could be a challenge.”
A well-run maternal mortality board can make an enormous difference in reducing maternal deaths. An example is in California, which developed the California Maternal Quality Care Collaborative (CMQCC) in 2006 to stem the rise of maternal mortality and morbidity rates.10,11 The collaborative analyzed maternal deaths, demographic and contributing factors, and opportunities for improvement. The effort worked: California decreased its maternal mortality rate by more than half.10,11
A 2018 study showed that California’s initiative led to its maternal mortality rate falling to a three-year average of 7.0 maternal deaths per 100,000 live births in 2013, half of what it had been in 2006. Its maternal morbidity rate was comparable to the average rate in Western Europe.11 “We’ve done a tremendous amount of work in California, helping hospitals implement evidence-based practices, and this helped reduce maternal mortality in California,” says Deirdre Lyell, MD, co-chair and co-principal investigator of the CMQCC and the California Perinatal Quality Care Collaborative (CPQCC) and a professor of obstetrics and gynecology at Stanford Medicine in Palo Alto, CA. (See the article about California’s efforts to reduce maternal mortality in this issue.)
The key factors in reducing maternal mortality were connecting public health surveillance to action steps, mobilizing public and private partners to work collaboratively, establishing a data system to support efforts, and implementing large-scale interventions, including integrating clinical providers with public health services.11
Melinda Young has been a healthcare and medical writer for 30 years. She currently writes about contraceptive technology.
References
- Ungar L. Maternal mortality review panels are in the spotlight. Here’s what they do. Associated Press. Dec. 5, 2024. https://apnews.com/article/maternal-mortality-cdc-abortion-georgia-texas-idaho-10dae96d52503709f4beb698a3f12db5
- Valenti J. Texas won’t report on maternal deaths. Abortion, Every Day. Nov. 26, 2024. https://jessica.substack.com/p/texas-wont-report-on-maternal-deaths
- Yurkanin A. Georgia dismissed all members of maternal morality committee after ProPublica obtained internal details of two deaths. ProPublica. Nov. 21, 2024. https://www.propublica.org/article/georgia-dismisses-maternal-mortality-committee-amber-thurman-candi-miller
- Belluck P. They had miscarriages, and new abortion laws obstructed treatment. The New York Times. July 17, 2022. https://www.nytimes.com/2022/07/17/health/abortion-miscarriage-treatment.html
- Georgia Department of Public Health letter. Nov. 8, 2024. https://www.documentcloud.org/documents/25362301-mmrc-member-letter-11-8-2024-1/
- Wagner B. Texas committee defends decision to skip reviews of post-abortion ban maternal deaths. Austin American-Statesman. Dec. 8, 2024. https://www.statesman.com/story/news/politics/state/2024/12/08/texas-maternal-mortality-committee-defends-decision-skip-post-abortion-ban-death-reviews-data/76804033007/
- Ungar L. Maternal mortality review panels are in the spotlight. Here’s what they do. Associated Press/News4jax. Dec. 5, 2024. https://www.news4jax.com/health/2024/12/05/maternal-mortality-review-panels-are-in-the-spotlight-heres-what-they-do/
- Mondestin T, Searing A, Osorio A. Medicaid expansion in Georgia would improve maternal and infant health outcomes. Georgetown University McCourt School of Public Policy, Center for Children and Families. Feb. 7, 2024. https://ccf.georgetown.edu/2024/02/07/medicaid-expansion-in-georgia-would-improve-maternal-and-infant-health-outcomes/
- Edwards E, Essamuah Z, Kane J. A dramatic rise in pregnant women dying in Texas after abortion ban. NBC News. Sept. 20, 2024. https://www.nbcnews.com/health/womens-health/texas-abortion-ban-deaths-pregnant-women-sb8-analysis-rcna171631
- Watt W, Mcilvena L. California may have the answer for lowering U.S. maternal mortality rates. GoodRx. Sept. 19, 2022. https://www.goodrx.com/hcp-articles/providers/lowering-maternal-mortality-rates
- Main EK, Markow C, Gould J. Addressing maternal mortality and morbidity in California through public-private partnerships. Health Aff. 2018;37(9):1484-1483.
Maternal mortality review committees are facing changes that could affect how maternal deaths are investigated and reported. This could lead to fewer initiatives to lower maternal mortality and morbidity rates and also mask could increases in abortion-ban states.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content. TESTING
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content