HJBR Jul/Aug 2019

Healthcare Journal of BATON ROUGE I  JUL / AUG 2019 25 C ongress moved a big step closer on Tuesday toward addressing one of the most fundamental problems underlying the maternal mortality crisis in the United States: the shortage of reliable data about what kills American mothers. The House of Representatives unani- mously approved H.R. 1318, the Preventing Maternal DeathsAct, to help states improve how they track and investigate deaths of expectant and new mothers. The bipartisan bill authorizes $12million a year in new funds for five years — an unprec- edented level of federal support — for states to create review committees tasked with identifying maternal deaths, analyzing the factors that contributed to those deaths and translating the lessons into policy changes. Roughly two-thirds of states have such pan- els, but the legislation specifically allocates federal funds for the first time and sets out guidelines they must meet to receive those grants. “We’re going to investigate every single [death] because these moms are worth it,” Rep. Jaime Herrera Beutler, R-Wash., the lead sponsor, testified at a hearing in Sep- tember. Lisa Hollier, president of theAmeri- can College of Obstetricians and Gynecol- ogists, called the legislation a “landmark.” The full Senate still needs to give its approval, with only a few days to act before the end of the current session. Senators have already authorized the necessary funding, in budget legislation that passed this year. As ProPublica and NPR have documented in the “Lost Mothers”series, maternal deaths have been rising in the U.S. in recent years even as they declined in other wealthy coun- tries. More than 700women die each year in America from causes related to pregnancy or childbirth, while at least 50,000 suffer life-threatening complications. Nationally, black women have a maternal mortality rate three to four times higher than that of white women. At least 60 percent of mater- nal deaths are preventable. Among the reasons the U.S. has fallen behind other countries, one stands out: gov- ernment failures to collect accurate data and to studymaternal deaths and near-deaths to understand how they might be prevented. State maternal mortality review com- mittees can play a key role in this process, public health experts say. They are particu- larly critical to understanding and narrow- ing racial disparities in outcomes. They have uncovered the surprising fact that cardiac- related issues are the leading cause of death for mothers and that the majority of deaths don’t occur during childbirth but in the days and weeks after birth. But many committees have little or no funding and rely on volunteers to do their work. They publish reports irregularly and, in some cases, do not address the issue of preventability at all.As a result, manymater- nal deaths have gone miscategorized or uncounted, and many researchers and cli- nicians have formed a distorted picture of why mothers die, often putting the blame unfairly on women themselves instead of medical providers, hospital systems and other factors. The House bill says that reviews are “essential” for “developing prevention efforts and quality improvement and qual- ity control programs.” It adds, “The United States must identify at-risk populations and understand how to support them to make pregnancy and the postpartumperiod safer.” The guidelines for receiving federal funding dictate how committees should bemade up and how evaluators should find and count deaths. Members of Congress have introduced other bills in recent years to try to prod states to establish review committees or strengthen existing ones. But maternal mor- tality wasn’t seen as a serious problem, and the legislation was usually associated with one political party, Democrats. The bills did not gain traction. The “Lost Mothers”series and a deluge of other media reports changed that, helping to create an unprecedented sense of urgency, maternal health advocates say. “I don’t think we would be as far as we are without that,” said Kathryn Schubert, chief advocacy offi- cer for the Society for Maternal-Fetal Medi- cine, whosemembers are doctors specializ- ing in high-risk pregnancies. “Every day, I get a call from somebody saying: ‘Oh my God, this is a real problem. We have to do some- thing,’ because they’ve read it in the news.” The news stories have also inspiredmoth- ers who have survived life-threatening com- plications and relatives of women who died. “It became the call to arms,”said Eleni Tsigas, head of the Preeclampsia Foundation and a co-founder of a new coalition of maternal health organizations, MoMMA’s Voice. The nonstop advocacy by patients and doctors — and even groups like March of Dimes, which has traditionally been more focused on infant health — has been effec- tive. “Twelve million dollars [per year] was more than we originally had in the legisla- tion,”Schubert said. “That never happens. … They put inmoney that we didn’t even dream of asking for at this point.” The other important factor in the legisla- tion’s success has been bipartisanship: The House bill and its Senate companion, S-1112, were introduced by Republicans as well as Democrats, and both have acquired many supporters along the way. Even so, despite having some 190 co-sponsors, the House bill remained stalled in committee for most of the past two years, coming unstuck in recent weeks after a lobbying blitz by med- ical groups and patient advocates. Several more-sweepingmaternal-related bills are pending on Capitol Hill, and just last week, the Senate approved a bill aimed at reducing chronic shortages of maternity care providers in some parts of the country, sending it to the president to sign. Mean- while, lawmakers outsideWashington have also been active — at least six states have passed bills in the past year establishing or strengthening their maternal mortality review panels. n