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Administrator Briefs Congress

Rep. Earl L. "Buddy" Carter (R-Ga.), third from left, and congressional staff listened in Tuesday as Dr. George Sigounas outlined agency efforts to reduce maternal mortality.
Rep. Earl L. "Buddy" Carter (R-Ga.), third from left, and congressional staff listened in as Dr. George Sigounas outlined agency efforts to reduce maternal mortality.

 

"In 2016, HRSA programs provided health care services to over 61 million mothers and children in the U.S., including 84 percent of all pregnant women and 63 percent of all infants and children ... With the ability to reach millions of people, HRSA continues to address maternal death collectively, using innovative ways."    - Dr. George Sigounas

 

Dr. Sigounas discussed agency assets on the ground, strategies and hallmark efforts — notably HRSA's first international summit on maternal morality in June 2018, which brought together 130 experts, representatives of six countries and officials of the World Health Organization to discuss best practices in the fight against maternal mortality.

Dr. Sigounas discussed agency assets on the ground, strategies and hallmark efforts — notably HRSA's first international summit on maternal mortality in June 2018, which brought together 130 experts, representatives of six countries and officials of the World Health Organization to discuss best practices in the fight against maternal mortality. Also addressing the body were (from left) RADM Kerry Nesseler, Dir., Office of Global Health;  Dr. Michael Warren, Associate Administrator, Maternal and Child Health Bureau (MCHB); and Laura Kavanagh, Deputy Associate Administrator, MCHB.

Maternal mortality remains a universally recognized public health priority, despite efforts and some success in addressing this issue.  Maternal mortality is a key indicator of health and is associated with accessibility of maternal and other health care services in a country.

"For every maternal death, there are nearly one hundred pregnant women that suffer from a traumatic event or near death experience," Dr. Sigounas said. "We can and should do better. The data shows us that nearly 60 percent of all pregnancy-related deaths are preventable."

Globally, maternal mortality rates have fallen by nearly 44 percent from 1990 to 2015, said RADM Kerry Nesseler. Yet, maternal mortality remains high. Recently, the global maternal mortality ratio was estimated at 216 maternal deaths per 100,000 live births, while the U.S. maternal mortality rate has been estimated at 18 per 100,000 births, which is considered high for a developed country.

Dr. Michael Warren, Associate Administrator of MCHB, told the audience that HRSA has added a new maternal mortality reporting requirement to its Title V Block Grant program, which he called "the biggest lever we have for improving women's health, including reducing maternal mortality and morbidity." The bureau also has commissioned a study of key factors that contribute to successful pregnancies in the U.S. and three countries represented at the summit.

"State Title V programs are also working to reduce maternal mortality and morbidity through a variety of approaches," he added. Those would include: supporting maternal mortality review committees to identify causes, monitor trends, and prevent future deaths; preventing low-risk cesarean deliveries; increasing annual well woman visits; and reducing the prevalence of risky behaviors such as smoking and substance use disorders during pregnancy to reduce hazards in delivery.

Laura Kavanagh, Deputy Associate Administrator of MCHB, described the agency's "AIM initiative" -- currently underway in 18 states and more than 990 birthing hospitals. The campaign seeks to implement maternal "safety bundles" that address the leading causes of maternal death, such as hemorrhage and hypertension. These are are small, straightforward sets of evidence-based practices that can cut severe maternal morbidity and mortality.  Broader adoption of the bundles and other proven practices can improve the quality and safety of maternity services throughout the U.S., she said.

Kavanagh noted that international participants in the HRSA summit pointed to "continuity of care" as a bellwether in reducing fatalities. In particular, the employment of nurse midwives who work with expectant mothers over the course of their pregnancies is underutilized in the U.S. due to a variety of issues, including the narrow workforce pipeline and limitations in some states on the scope of nursing practice.

Adopting a team-based approach that includes midwives and other health care practitioners could improve outcomes, Kavanagh said -- as would the availability of national surveillance and survey data-sharing to speed the adoption of practice improvements.

See HRSA's maternal mortality infographic (PDF - 544 KB).

Date Last Reviewed:  November 2018