Reducing Maternal Mortality, a Healthy People 2030 Leading Health Indicator

June 17, 2024 | Corinne Gillenwater

U.S. maternal mortality statistics are staggering: In 2022, there were 22.3 maternal deaths per 100,000 live births. And the crisis has only worsened over time—between 1999 and 2022, maternal mortality rates doubled among all people. Black and American Indian and Alaska Native women are disproportionately impacted, with maternal mortality rates approximately three and two times higher than the rate for White women, respectively, according to 2016-2018 data. Furthermore, the United States has one of the highest maternal mortality rates among other high-income countries, climbing to more than three times their rates in 2020. Sadly, these statistics largely tell of tragedies that could have been avoided, as over 80% of pregnancy-related deaths in the United States from 2017 to 2019 were preventable.

These data show that maternal health is in a concerning state, yet it is largely overlooked and underprioritized. ASTHO recognizes that more must be done and collaborates with partners to raise awareness for maternal health as well as build capacity for public health leaders to reduce maternal mortality.

Maternal Mortality Is a Public Health Priority

The urgency of the maternal mortality crisis is front of mind for state health officials, as maternal, child, and family health (MCFH) topped the list of ASTHO’s 2023 Environmental Scan of Current and Emerging Public Health Priorities. Due to an influx of responses focused on MCFH topics, ASTHO published a brief on MCFH-specific findings, highlighting the need for maternal and infant mortality prevention. In addition, territorial health officials elevated maternal, infant, and child health care as a public health program and service priority under the focus on access to and linkage with care.

Maternal mortality is also a key priority issue in the Healthy People 2030 framework, which outlines data-driven national objectives to promote health, well-being, and health equity over the next decade. Among these objectives are 23 high-priority Leading Health Indicators (LHIs)—selected to help organizations, communities, and state and territorial health departments focus resources and efforts—one of which is reducing maternal deaths. This reflects, yet again, the critical importance of prioritizing maternal health in the United States. There is detailed data, a description of data methodology and measurements, and evidence-based resources for this LHI, which the Office of Disease Prevention and Health Promotion updates regularly.

ASTHO’s Work to Reduce Maternal Mortality

ASTHO’s Maternal and Infant Health (MIH) team advances the LHI to reduce maternal deaths in its daily work. It facilitates learning communities and develops capacity building and technical assistance resources that can help state and territorial health officials (S/THOs) promote maternal health and well-being.

Learning Communities

• The Promoting Innovation in State and Territorial Maternal and Child Health Policymaking (PRISM) Learning Community provides technical support to build capacity for addressing substance use and co-occurring mental health conditions in maternal and child health populations. It supports state and territorial health agencies (S/THAs) with implementing evidence-based strategies to improve access to person-centered treatment and care.
• The Risk-Appropriate Care Learning Community brings together experts to address knowledge gaps and advance neonatal and maternal levels of care. It supports states and territories in developing and implementing experience-informed, data-driven best practices for risk-appropriate care, aligning with implementation of the CDC Levels of Care Assessment Tool.

Knowledge Sharing

• Addressing the racial/ethnic gap. The Maternal Mortality and Morbidity Policy Statement offers recommendations for addressing the social, economic, and clinical barriers that impact maternal health. To support this work, the MIH team developed “Supporting Success: ASTHO's Strategies for Reducing Maternal Mortality and Morbidity,” a technical package that includes effective interventions for reducing maternal deaths that S/THAs can adapt to their jurisdictions’ needs. Strategic priorities include: (1) health and racial equity and workforce development, (2) sustainable infrastructure improvements, (3) data modernization and interoperability, and (4) evidence-based and promising public health practices.
• Covering pre-existing and pregnancy-related health conditions and disparities. “Addressing Hypertension in Pregnancy to Reduce Maternal Morbidity and Mortality,” a brief emerging from the Alliance for Innovation on Maternal Health, raises awareness for hypertension (e.g., gestational hypertension, pre-eclampsia/eclampsia, and chronic hypertension) as a leading clinical cause of maternal death. It also identifies health agency strategies to address this public health issue, such as leveraging community health workers and supporting Medicaid coverage for self-measured blood pressure monitoring.
• Tackling rural health disparities. The “Improving Financial Access to Maternal and Infant Care in Rural Areas” brief and “Addressing the Impact of Rural Hospital Closures on Maternal and Infant Health” blog post acknowledge barriers and provide actionable strategies for rural health equity for pregnant people.
• Acknowledging maternal mental health and substance use disorder (SUD). The “Utilizing Doula Care to Support Substance Use Disorder in the Postpartum Period” brief elevates the burden of SUD on pregnant and postpartum people and recommends engaging doulas with lived experience as vital members of the perinatal behavioral health workforce. The team puts forward effective policy strategies to increase access to and insurance coverage of doula services in the blog post “Increasing Access to Doulas Will Ease the Maternal Health Crisis.” Additionally, the “Health Agency Innovations in Financing Maternal Mental Health” brief features state partnership examples and Medicaid coverage options.

Advancing Better Health Outcomes Together

ASTHO demonstrates a strong commitment to Healthy People 2030 objectives and priority areas of health equity, health literacy, and social determinants of health in our daily programmatic work. With the support of dedicated funding and a determination to advance LHIs through capacity building and technical assistance, ASTHO and Healthy People 2030 work together to help S/THAs achieve better health outcomes and promote health equity.

This blog post offers just a glimpse into the MIH team’s efforts to reduce maternal mortality and how it can support S/THOs in their own work. For S/THOs looking to learn more or get involved with MIH work at ASTHO, please email rac@astho.org. In addition, explore all 23 LHIs and determine how to best focus public health resources and interventions to meet specific community needs.