Maternal mortality review committees are in the spotlight. Here’s what they do

Efforts to reduce the maternal mortality still high rates involve panels of state experts who investigate and learn from each mother death.

The committees – called maternal mortality review committees – generally carry out their work quietly and away from public view. But that hasn’t been the case recently in three states with strict abortion laws.

Georgia fired all of its committee members in November after information about the deaths under review was leaked to the news organization. ProPublica. A few days later, The Washington Post reported that the Texas committee would not consider cases in 2022 and 2023, the first two years after the state banned nearly all abortions. In Idaho, the state let its panel disband in 2023 only to reinstate it earlier this year.

“They’ve become more of a lightning rod than before,” said epidemiologist Michael Kramer, director of the Center for Rural Health and Health Disparities at Mercer University in Georgia.

Here’s what maternal mortality review committees across the country are doing and what could happen next:

“Maternal mortality review committees are important because they are the most comprehensive source of information we have on maternal mortality,” said David Goodman, who leads the maternal mortality prevention team at the Centers for Disease Control and Prevention of the United States.

The panels examine deaths that occurred during pregnancy or in the year following its end, whether directly related to the pregnancy or not. Causes of death can range from hemorrhaging during childbirth to drug overdoses to road accidents.

The goal, Kramer said, is to look at maternal deaths and help “decide what we can do about them.”

All states, some cities and Puerto Rico have these committees. Their membership varies and can include obstetrician-gynecologists, maternal-fetal medicine physicians, nurses, midwives, mental and public health experts, and members of patient advocacy groups. Most have representatives from several areas of expertise, that the CDC recommends.

The way members are selected also varies; people can apply, submit letters of interest or be invited to serve.

The selection should not be politically motivated, Kramer said, because “if there is a systematic exclusion of certain data or certain perspectives,” it is difficult to really understand what is going on.

First, the panels work with vital statistics offices and epidemiologists to identify pregnancy-associated deaths by reviewing death certificates and looking for a pregnancy checkbox or related cause of death. They can also search for links to birth and fetal death records, or delve into hospital discharge data, media reports and obituaries.

Once cases are identified, they collect as much information as possible, such as prenatal care records, hospital and social service records, autopsy reports and interviews with family members. Professional “summaries” distill all of this into case stories, which committee members delve into. Most use a standardized review process developed by the CDC – and all panels can get help and guidance from the agency.

They examine questions such as: Was the death pregnancy-related? What was the underlying cause? Was this avoidable? What factors contributed?

States generally have confidentiality rules that protect committee members and people who provide information about deaths.

The groups then release public reports that don’t name moms or hospitals, but include general findings, trends and recommendations. Some come out a few years or more after the death.

Across the country, in 2023, Goodman said, 151 recommendations from these reports have been implemented by communities, hospitals, health professionals and policymakers.

Georgia will rebuild its committee through a new application process, the state’s public health commissioner said.

The Texas committee reviewed 2021 deaths and will begin reviewing 2024 cases at its next meeting, Lara Anton, a spokeswoman for the Texas Department of State Health Services, said in an email to to the Associated Press.

“Reviewing records is a lengthy process and lawmakers have requested more recent data. Starting the next review cycle with 2024 cases will allow us to provide this in the next report,” Anton said, adding that maternal and child health epidemiologists will continue to analyze and publish data for 2022 and 2023.

In Idaho, the reconstituted review board now reports to the state board of medicine, which licenses doctors, and no longer to the state Department of Health and Welfare. It will work as it always has, said Bob McLaughlin, a medical board spokesman. Members first met in November and plan to release a report by January 31. Because the Legislature wanted the most recent information, McLaughlin said the first report would only cover 2023 cases and the group would look at deaths from the next 2022.

Goodman said he is encouraged that every state now has a review board — only 20 did in 2015.

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