DC Action's Testimony at the Public Hearing on the Maternal Mortality Review Committee Establishment Act of 2017

Testimony of Shana Bartley, Acting Executive Director

DC Action for Children

 

Public Hearing on

B22-0522 The Maternal Mortality Review Committee Establishment Act of 2017

 

Before the Committee on the Judiciary and Public Safety

 

Council of the District of Columbia

 

December 7, 2017

 

DC Action for Children is pleased to provide written testimony in support of proposed legislation, B22-0522 The Maternal Mortality Review Committee Establishment Act of 2017. The proposed bill represents an important foundational step toward improving both maternal and child health in the District.

 

Simply put, the maternal mortality rate in DC is too high. This bill would institute a proven strategy – currently implemented in 28 other states – that would convene diverse subject-matter experts and advocates to review maternal deaths, identify causes of death and produce actionable recommendations on how to improve maternal health and prevent avoidable loss of life. The findings of this body would be a key component in enacting systems change to protect women’s health and improve birth outcomes in the District of Columbia.

 

DC Action for Children works to improve the lives of DC children and families by providing research and policy leadership centered on achieving equity for all children in the District. Our current efforts include supporting two-generation strategies for improving birth, child and family outcomes, and working to identify gaps in the maternal and child health system of care in the District to support improvements in the system that would ensure that mothers and babies are healthy. This work guides our understanding of and support for the Maternal Mortality Review Committee Establishment Act of 2017.

 

As advocates for strategies that promote positive child and family outcomes, we are acutely aware of the importance of maternal health and its impact on children--healthy mothers are more likely to give birth to healthy babies, and over time, children are healthier and experience more positive outcomes when their mother is healthy. The link between maternal and child outcomes cannot be overstated. During pregnancy, chronic maternal conditions such as obesity, diabetes, hypertension as well as parental environmental exposure and psychological stressors have an impact on fetal and infant health.[1] Not only does maternal health during pregnancy affect child health, but maternal presence also supports positive child outcomes after birth.[2] Therefore, protecting the lives of pregnant women and mothers is incumbent upon the District, both for the sake of the mother and of her child.

 

However, according to the March of Dimes analysis of the CDC’s National Vital Statistics System, DC has the highest maternal mortality rate in the nation, with over 40 deaths per 100,000 live births.[3] This rate is more than double the national average, which is the highest maternal mortality rate among developed countries and is the only maternal mortality rate that is rising.[4] DC’s rate is also almost four times as high as CDC’s Healthy People 2020 target rate of 11.4 maternal deaths per 1000 births.[5] A maternal mortality review commission could help the District understand the causes of these deaths, identify what could have been done to prevent them and provide recommendations on how to prevent future deaths.

 

The maternal mortality review commission could be especially valuable in reducing wide racial disparities in maternal mortality: according to the CDC, black women are 243% more likely to die from pregnancy or childbirth-related causes than white women, an inequality that is likely reflected or exceeded in DC.[6] Research finds that these disparities are not solely the result of factors associated with differences in income or education, as is often suggested. For example, New York City’s maternal morbidity report from 2016 finds that black, college-educated mothers who gave birth in local hospitals were more likely to suffer severe complications of pregnancy or childbirth than white women who never graduated from high school.[7] In order for a local maternal mortality review board to truly understand the local context and causes of maternal deaths in DC, race must be meaningfully examined as a factor for health and pregnancy outcomes. We recommend including language in this bill specifically requiring the committee to collect and review quantitative and qualitative data examining how women’s experiences and outcomes differ by race, income, and ward of residence.

 

Recent changes to DC’s maternal and child health system of care have the potential to impact the District’s already high maternal and infant mortality rates; these changes emphasize the need for close attention to maternal health outcomes. In the past year, two of DC’s seven hospital maternity wards closed, accompanying a shift in Medicaid managed care organizations that has altered the landscape and affected some women’s ability to receive care from their preferred providers. In response, other hospitals are building capacity to take on more patients as well as form new partnerships with community-based providers. Given already high maternal and infant mortality rates in DC, we are concerned about the cumulative impacts of these changes on maternal mortality in the District, especially amongst those pregnant women at greatest risk for negative birth outcomes, including maternal death. We believe that a maternal mortality review board, alongside preemptive strategies, is essential to monitoring the effects of these changes and sharing findings that may prevent future deaths.

 

Finally, although maternal deaths are tragic and DC’s current maternal mortality rate is unacceptable, death is an unlikely outcome for most. Much more common and in need of focus are cases of maternal morbidity, particularly severe maternal morbidity.[8] These are birth outcomes that result in significant short- or long-term consequences to a woman’s health.[9] Maternal morbidity, in addition to negatively impacting maternal and child health, is costly to the women it affects (during an already expensive medical experience) and increases burden and cost to the health system. We recommend that, following the example of other states, this bill mandates that the maternal mortality review commission also review maternal morbidity cases. While the type of review and the resources needed will differ from those for maternal mortality, we believe that attention to morbidity would strengthen the work of this body. By reviewing these cases and identifying patterns in causation, this committee could help the health system preempt negative outcomes and ensure more positive birth experiences for families in the District.

 

We applaud the Council for its attention to maternal health. No woman in DC should fear for her life when she discovers that she is pregnant. This bill is an excellent measure to ensure that preventable maternal mortality never happens in DC and that mothers and children experience positive birth outcomes. We look forward to seeing this bill enacted and welcome any questions in the meantime.

 

 

 

 

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[2] Ibid.

[3] National Center for Health Statistics, final mortality data; National Center for Health Statistics, final natality data.

Retrieved December 19, 2017, from www.marchofdimes.org/peristats.

[8] According to the Centers for Disease Control and Prevention, in the US, 144 in 10,000 births result in severe maternal morbidity vs the national maternal mortality rate of 17.3 deaths per 100,000 live births

[9] The Joint Commission. Comprehensive Accreditation Manual for Hospitals, Update 2, January 2015: Sentinel Events: SE-1. Available at: http://www.jointcommission.org/assets/1/6/CAMH_24_SE_all_CURRENT.pdf

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