The Minnesota Department of Health (MDH) today released its first-ever Minnesota Maternal Mortality Report (PDF), which examined maternal deaths during or within one year of pregnancy from 2017 to 2018.
While the report shows the state’s overall maternal mortality rate is much lower than the national average, it also shows stark disparities in mortality – especially among Black and American Indian Minnesotans. Black Minnesotans represent 13% of the birthing population but made up 23% of pregnancy-associated deaths, and American Indian Minnesotans represent 2% of the birthing population, but 8% of pregnancy-associated deaths.
“The health of our mothers is a key indicator of the health of our state,” said Minnesota Commissioner of Health Jan Malcolm. “Each maternal death is tragic, and the racial disparities we see in the data are alarming. We mourn those Minnesotans who died and the impact of the losses on families and communities. This report is a critical first step to finding ways to prevent these deaths both inside and outside health care settings.”
The report includes data from 48 people who died during pregnancy or within one year of the end of pregnancy, from any cause, in 2017-2018. These deaths are called “pregnancy-associated deaths,” even if pregnancy did not cause the death, for example, in a motor vehicle accident.
Included in pregnancy-associated deaths are those that occurred from a pregnancy complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiologic effects of pregnancy, for example severe bleeding or high blood pressure – these are called “pregnancy-related deaths.”
The report includes data reviewed by the Maternal Mortality Review Committee, a multidisciplinary committee established in Minnesota statue and comprised with diverse representation from the maternal health field, public health, and community organizations.
Some key findings
- The state’s pregnancy-related mortality ratio (PRMR) for 2017-2018 was 8.8 pregnancy-related deaths per 100,000 births compared to the national ratio of 17.3 pregnancy-related death per 100,000 births in 2017.
- Most of the pregnancy-associated deaths occurred from six weeks after the pregnancy to one year postpartum (62.5 %). 20.8% occurred during pregnancy, and 16.7% occurred 0-42 days postpartum.
- Injury was the leading cause of death for pregnancy-associated deaths. This included deaths related to motor vehicle accidents, poisoning/overdose, and violence from homicide or suicide, including firearms.
- Substance use was identified as a cause or contributing factor in 31.3% of the pregnancy-associated deaths.
“Our work identifies a significant need for focused services after pregnancy delivery, during what is now being called the fourth trimester, given that well over half of pregnancy-associated deaths occur during this time,” said Dr. Cresta Jones, associate professor at the University of Minnesota Medical School and co-chair of the Maternal Mortality Review Committee. “Typically, individuals are not seen after delivery for 6-12 weeks, but earlier and more frequent post-delivery follow up will help identify patients most at risk, include those with substance use or a substance use disorder and those with other conditions placing them at higher risk of death by suicide.”
Public health literature shows systemic racism and generational structural inequities contribute to poor health outcomes. This can have a greater influence on health outcomes than individual choices or one’s ability to access health care, and not all communities are impacted the same way. These inequities likely play a role in pregnancy-associated deaths. These inequities can further exacerbate disparities like those identified in this report and should be considered and acknowledged in efforts to address them.
“In one of the healthiest states in the country, Black and Indigenous moms are dying at a rate that far outstrips their share of the population,” said Dr. Rachel Hardeman, Director of the Center for Antiracism Research for Health Equity at the University of Minnesota and co-chair of the Maternal Mortality Review Committee. “This is not a coincidence. It is a reflection of the historical legacy of structural racism that has shaped current inequities in maternal mortality. These deaths are 100% preventable, and Minnesota has the opportunity to lead the way in implementing change within our communities to alter this trajectory. Structural racism is a fixable problem, and we all have a role to play in the solutions.”
The trends identified in this report reveal unmet needs and opportunity for public health interventions at the community and systems levels. The report provided some key policy recommendations:
- Support people enrolled in Medicaid to access essential services throughout pregnancy and one-year post-partum. Expanded coverage under Medicaid began July 1, 2022, in Minnesota, following a change in statue by the Minnesota Legislature and change in policy by the U.S. Department of Health and Human Services earlier this year.
- Connect birthing people and families to resources and support throughout pregnancy and postpartum period to address food insecurity, housing, transportation, safety, mental health, and substance use.
- Address bias and cultural competency in health care and public health, and how it impacts birthing people and their families. Enhance cultural and trauma-informed mental health and behavioral health care services.
- Listen to concerns of birthing people and provide a network of support during pregnancy, delivery, and throughout the postpartum period.
These steps could help address underlying root causes contributing to the disparities.
The data also highlights opportunities for other public health interventions, like tailoring substance misuse prevention or mental health management for pregnant or new parents and taking extra steps to identify and prevent violence with people during or after pregnancy.