REFORM (MO) Report: Nearly 85% maternal deaths in Missouri were preventable

MM Curator summary

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[MM Curator Summary]: Reminder- the maternal mortality crisis in Medicaid is NOT during labor and delivery. We need to be more accurate and address it as a broader MH/SUD problem if we want to start impacting this tragedy.



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JEFFERSON CITY, Mo. – The state is making a historic investment in a maternal mortality prevention plan after learning Missouri has one of the highest rates of pregnancy-related deaths in the country.

In a new report, an average of 70 Missouri women died while pregnant or within one year after giving birth between 2018 and 2020. The Missouri Hospital Association (MHA) said Tuesday the most sobering piece of the report is nearly 85% of those deaths were preventable.

“Maternal mortality rates in Missouri are not great,” MHA spokesperson Renee Wilde said. “We are well below the national average, and we know that’s something we need to improve on.”

Missouri is looking at new ways to help save new moms. According to a recent report from the state’s Pregnancy-Associated Mortality Review (PAMR) Board, the number one cause of pregnancy-related deaths was mental health conditions, including substance use disorders.

“One thing that this report shows is that the highest occurrence of these deaths happen between 43 days and 365 days postpartum,” Wilde said. “So, it’s not that we’re even seeing these deaths during pregnancy, during childbirth, or even immediately after childbirth.”

The second leading cause is cardiovascular disease, like high blood pressure, followed by homicides. The number of suicide deaths doubled when compared to 2017-2019 with 2018-2020.

The PAMR Board found that the pregnancy-related mortality ratio was 32 deaths per 100,000 live births, which is up from 25.2 deaths in the 2017-2019 time frame. The report found the highest number of pregnancy-related deaths happened in 2020, at 85 deaths.

“The report also showed Black women have a three-times higher instance of maternal mortality than white women,” Wilde said.

Last week, a new law went into effect, extending Medicaid coverage for new moms four up to one year after the baby is born. By extending the coverage for up to one year after giving birth, the legislation is estimated to help more than 4,200 new moms a year.

“We know that health care access is critical and if you don’t have insurance, you probably are a lot less likely to receive prenatal care to continue seeking care postpartum and really getting those conditions treated,” Wilde said.

More than half of the country has already extended Medicaid coverage for new moms and the bipartisan legislation approved by the General Assembly this year is not only expected to save lives but cover thousands of women who would otherwise go uninsured two months after giving birth. Due to a provision in the federal American Rescue Plan Act of 2021, each state is allowed to expand Medicaid coverage to women up to 12 months. The state recently started Medicaid eligibility renewals again after the federal government prohibited states from removing people from Medicaid for three years.

Since the governor has signed the bill, the Department of Social Services (DSS) is reviewing to see which Medicaid patients recently gave birth or if currently pregnant, are eligible for the postpartum program. DSS said you’re a new mom on Medicaid who gave birth back in May, you will still receive extended postpartum care for up to 12 months.

“I thought if there was ever a time to spend money, what better way to spend it than on mothers and children,” Governor Mike Parson said. “We know we need to do a better job for it.”

The state is also spending more than $4.35 million to create a maternal mortality prevention plan. In addition, the General Assembly also funded four recommendations centered around improving the state’s maternal mortality.

  • Provide funding for a statewide Perinatal Quality Collaborative by 2023
  • Establish and fund a statewide Perinatal Health Access Project to aid healthcare providers in providing evidence-based mental health care, including substance use disorder treatment
  • Extend Medicaid coverage to one year postpartum for all conditions, even if the woman did not start treatment prior to delivery
  • Fund Medicaid expansion in 2023

“I think that’s why we did the appropriations this year. It’s one of the largest investments in really trying to change the need in that,” Parson said. “Now just to go out there and kind of talk about it but how do we really help those moms and those babies out there to make sure we save lives.”

The report shows that before extending coverage, women on Medicaid were 10 times more likely to die within one year of pregnancy than new moms on private insurance.

Back in January during his annual State of the State Address, Parson called the state’s high maternal mortality rate “embarrassing.”

Wilde says it will take years for Missouri to improve from having the 12th highest maternal mortality rate in the nation.

“I would say it’s shocking that we’re not seeing some sort of improvement,” Wilde said. “You would think with modern medicine and better access to care that we would be seeing slight improvements. We really are optimistic that with all of these programs that are being put in place, the funding and the legislation that we will start to see that needle move in a positive direction.

The report also found that women living in metropolitan counties were almost twice as likely to die of a pregnancy-related death than women in rural counties.

Click here to see the full 2018-2020 PAMR Board report.