August 4, 2022
The Minnesota Department of Health (DOH) released the first today Minnesota Maternal Mortality Report (PDF)which examined maternal deaths during or within one year of pregnancy from 2017 to 2018.
While the report shows that the state’s overall maternal mortality rate is well below the national average, it also shows stark disparities in mortality — especially among Black Minnesotans and American Indians. Black Minnesotans represent 13% of the birth population but accounted for 23% of pregnancy-related deaths, and American Indian Minnesotans represent 2% of the birth population but 8% of pregnancy-related deaths.
“The health of our mothers is a key indicator of the health of our state,” said Minnesota Health Commissioner Jan Malcolm. “Every 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 loss on families and communities. This report is a critical first step in finding ways to prevent these deaths inside and outside of health care settings.”
The report includes data from 48 people who died during pregnancy or within a year after the end of pregnancy, from any cause, in 2017-2018. These deaths are called “pregnancy-related deaths,” even if the pregnancy did not cause the death, for example, in a car accident.
Pregnancy-related deaths include those that occur from a complication of pregnancy, a chain of events triggered by pregnancy, or worsening of a condition unrelated to the physiological effects of pregnancy, for example heavy bleeding or high blood pressure – these called “pregnancy-related deaths.”
The report includes data reviewed by the Maternal Mortality Review Committee, a multidisciplinary committee established in Minnesota and comprised of diverse representation from maternal health, 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 rate of 17.3 pregnancy-related deaths per 100,000 births in 2017.
- Most pregnancy-related deaths occurred between six weeks after pregnancy and one year after birth (62.5%). 20.8% occurred during pregnancy and 16.7% occurred 0-42 days after birth.
- Injury was the leading cause of death for pregnancy-related deaths. This included deaths related to motor vehicle accidents, poisonings/overdoses, and murder-suicide violence, including firearms.
- Substance use was identified as a cause or contributing factor in 31.3% of pregnancy-related deaths.
“Our work identifies a significant need for focused postpartum services during what is now called the fourth trimester, given that more than half of pregnancy-related 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 postpartum for 6-12 weeks, but earlier and more frequent postpartum follow-up will help identify patients most at risk, including those with substance use or a substance use disorder. substances and those with other conditions that place them. at higher risk of death by suicide.”
The public health literature shows that systemic racism and structural generational inequities contribute to poor health outcomes. This can have a greater impact on health outcomes than individual choices or one’s ability to access health care, and not all communities are affected in the same way. These disparities likely play a role in pregnancy-related deaths. These disparities may further exacerbate inequalities such as 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 mothers are dying at a rate that exceeds their share of the population,” said Dr. Rachel Hardeman, Director of the Center for Antiracist Research on 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 inequalities in maternal mortality. These deaths are 100% preventable and Minnesota has the opportunity to lead the way in implementing changes within our communities to reverse 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 opportunities for public health interventions at the community and systems levels. The report made several key policy recommendations:
- Support people enrolled in Medicaid to access essential services during pregnancy and one year after birth. Expanded coverage under Medicaid began July 1, 2022, in Minnesota, following a change in the statue by the Minnesota Legislature and a policy change by the U.S. Department of Health and Human Services earlier this year.
- Connect birthing people and families to resources and support during pregnancy and the postpartum period to address food insecurity, housing, transportation, safety, mental health, and substance use.
- Address bias and cultural competence in health care and public health, and how it affects people who give birth and their families. Improving culturally and trauma-informed behavioral health and mental health services.
- Listen to the concerns of people giving birth and provide a network of support during pregnancy, birth and throughout the postpartum period.
These steps can help address the root causes that contribute to inequalities.
The data also highlight opportunities for other public health interventions, such as tailoring substance abuse prevention or mental health management to pregnant or new parents and taking additional steps to identify and prevent peer violence during or after pregnancy.
Questions for the media: