California’s Surgeon General has released a plan to reduce maternal mortality, setting a goal of halving pregnancy- and childbirth-related deaths by December 2026.
Health officials say 50% of maternal deaths nationwide are preventable. California has achieved a much lower maternal mortality rate than the U.S., but in recent years, amid the COVID-19 pandemic, .
“We have the lowest death rate in the country, and we can do better now,” Dr. Diana E. Ramos, California’s public health commissioner, said in an interview.
He announced the effort with Ramos on Tuesday, accompanied by his first partner, Jennifer Siebel Newsom, wife of Gov. Gavin Newsom.
In California, the leading causes of these deaths include heart disease, bleeding, “behavioral health” issues such as mental illness and substance use, and infectious diseases. More than one-fifth of pregnancy-related deaths in California occur on the day of delivery, but the vast majority occur in the days, weeks and months afterward, the department reports.
The crisis is especially pronounced among Black women, who face maternal mortality rates more than three times higher than white women in California. Los Angeles County has seen public outcry in recent years over the deaths of Black mothers like Ashley, 31, and Bridget Burks, 32, whose deaths have devastated their families.
Health researchers point to a number of factors for Black women’s higher maternal mortality rates, including the physical toll of years of racism, higher rates of diabetes and other chronic diseases that increase risk, and inequities in the health care Black patients receive.
California officials said they are also concerned about rising maternal mortality rates in the state’s Latino and Asian and Pacific Islander communities.
Officials say the initiative will help patients understand potential risks before they become pregnant and encourage earlier action to address risks like heart disease. It will also inform Californians about doula services and other programs aimed at helping people before, during and after birth.
Ramos said California achieved one of the highest maternal mortality rates in the country through a system centered on hospitals, doctors and other health care professionals, as well as other efforts. Until now, “the focus has been primarily on the health care setting,” she said.
But “if we continue to do the same thing and focus only on the medical team, we’re going to get the same results,” Ramos said. Health officials and experts decided they needed to step up their efforts, “which is why we’re bringing in the patients.”
“It seems so simple, but often pregnant women don’t have a voice or the information they need to make an informed decision,” Ramos said.
“Reducing maternal mortality is not a should thing, it’s a must thing. California understands that,” U.S. Health and Human Services Secretary Xavier Becerra said in a statement announcing the new initiative.
The planning strategies outlined in the report released Tuesday include a new questionnaire that patients can complete at home to assess their risk of pregnancy complications and then get recommendations on next steps based on the results.
Ramos, the obstetrician-gynecologist, said she’s noticed that the first time patients are told, “You’re going to be a high-risk patient,” is often during their first prenatal visit. And often, patients say, “I wish I’d known I could have done X, Y, Z to reduce my risk.”
California officials also want all medical facilities in the state to use it to gauge risk levels in pregnant patients.
Ramos said these results could help guide where patients go for delivery: Hospitals with limited resources could refer patients at higher risk of complications, such as those at risk of bleeding or being admitted to intensive care, to medical facilities best suited to treat them.
The new initiative comes as pregnant patients may have fewer options for giving birth in hospital, with research showing that around a quarter of maternity units nationwide are set to close in 2021 and 2022.
“In the modern fee-for-service model of care, hospitals must cover the costs of around-the-clock care, but are only paid when their facilities and staff are active,” Dr. Anna Reinert, assistant professor of clinical obstetrics and gynecology at the Keck School of Medicine of the University of Southern California, said in the paper.
“So if there aren’t enough births, expenses exceed compensation, which leads hospitals to get out of the birth business altogether,” Reinert wrote.
California has faced a wave of hospital closures over the past decade, including at hospitals across the state, where studies have found that these closures disproportionately impact Black, Latino, and low-income communities. One of the latest hospitals to announce the closure of its labor and delivery unit was USC Verdugo Hills Hospital in Glendale, which closed on November 20.
