New Commentary Emphasizes the Roles of Measurement and Social Determinants in Improving Maternal Mortality Rates in the US

In a new commentary published this September in JAMA, Dr. Michael Lu of the Milken School of Public Health at George Washington University outlines three strategies for reducing maternal mortality in the United States. These strategies include “learning from every maternal death, ensuring quality and safety of maternity care for all women, and improving women’s health across the life course.” Although he focuses on the United States, the recommendations he provides are universal. Improving the ability to learn from all deaths by strengthening data quality, availability, and reporting as well as emphasizing the important role social determinants of health play in maternal mortality are two areas the EPMM Strategies highlight, and that the IMHM project is currently working to address.

Learning from every maternal death means strengthening national civil registration and vital statistics systems so that all deaths are counted and ensuring that all deaths undergo comprehensive maternal mortality reviews. Indeed, Lu asserts that maternal mortality review committees are vital to “comprehensively assess[ing] causes of death and opportunities for prevention.” According to the World Health Organization, just 89 out of 110 surveyed countries have a national policy that all maternal deaths must be reviewed, and just 76 of those countries have a maternal death review committee in place. But a policy or committee does not guarantee a functioning system; Lu notes that even in a high-income country like the United States, the Pregnancy Mortality Surveillance system is constrained by data limitations and requires an expanded surveillance system.

Lu writes that “achieving zero maternal deaths will require improving women’s health not only during pregnancy but also across their life course.” Poverty, racism, and other manifestations of social inequality all have deleterious consequences on women’s health and contribute to maternal mortality. The EPMM Strategies similarly stress the importance of acknowledging and addressing the social, political, and economic factors that affect the health of women and girls. The IMHM project aims to strengthen the ability to monitor the more distal, upstream determinants of maternal health by validating indicators that track health system performance and the full range of determinants of maternal health and survival, and by improving the data that country decision-makers can use to identify and track relevant factors in their settings.

Lu’s three strategies for reducing maternal mortality are applicable beyond the borders of the United States, much like the EPMM Strategies, which apply to all countries regardless of economic status or geographic location. By working to improve maternal health measurement capacity and use and focusing on the social determinants of maternal health and survival, the EPMM Strategies and IMHM project aim to support countries in making strides towards ending preventable maternal mortality. Because as Lu points out, “in the 21st century no woman”—in the United States or elsewhere— “should ever die of complications related to pregnancy and childbirth.”

Access the commentary | “Reducing Maternal Mortality in the United States”